BPPV, Meniere's and Vestibular neuronitis

Question 1

What is the cause of Meniere’s disease?

Answer 1

Idiopathic endolymphatic hydrops: either from increased production or decreased resorption.
It involves dilatation of endolymphatic spaces of the membranous labyrinth.

Question 2

Does Meniere’s disease usually affect one or both ears?

Answer 2

Meniere’s usually affect 1 ear initially. It will affect the other ear later in 4/10 patients.

Question 3

What are the symptoms of Meniere’s disease?

Answer 3

Vertigo lasting for minutes to hours.
Fluctuating sensori-neural hearing loss.
Tinnitus.
Ear pressure: a sense of fullness inside the ear
Associated with nausea and vomiting

Question 4

What are the symptoms of BPPV?

Answer 4

Rotational vertigo lasting less than 1 min, usually for 20-30 seconds
Vertigo is triggered with head movement.
May have associated nausea and vomiting.

Question 5

What does BPPV stands for?

Answer 5

Benign Paroxysmal Positional Vertigo.

Question 6

On average, how long does each episode of Meniere’s last for?

Answer 6

2-4 hours.

Question 7

Describe the vertigo attacks in Meniere’s disease.

Answer 7

In Meniere’s disease, the attacks come in clusters (several attacks coming in quick succession to one another.)

Question 8

What type of hearing loss is associated with Meniere’s disease?

Answer 8

Sensori-neural hearing loss.

Question 9

What is the age of onset of Meniere’s disease?

Answer 9

40-60 years old

Question 10

What can aggravate or relieve the symptoms of vertigo in Meniere’s?

Answer 10

Lying in bed helps dampen symptoms but loud noises can aggravate symptoms.

Question 11

What is Vestibular Neuronitis?

Answer 11

Vestibular Neuronitis is an infection of the vestibular nerve in the inner ear, causing the vestibular nerve to become inflamed.

Question 12

Is hearing affected in Vestibular Neuronitis?

Answer 12

No

Question 13

Is hearing affected in Labyrinthitis?

Answer 13

Yes

Question 14

Is tinnitus present in Vestibular Neuronitis?

Answer 14

No

Question 15

What normally precedes Vestibular Neuronitis?

Answer 15

A viral infection

Question 16

Describe the nystagmus seen in Vestibular Neuronitis.

• Direction of nystagmus (fast phase)
• What reduces the speed of the nystagmus.

Answer 16

Nystagmus is often fine horizontal, but may be horizontal-torsional, with the fast phase away from the affected ear. (towards the contralateral side)
It always beats in the same direction, even if head is rotated.
Fixing the eyes on a point will reduce the speed of the nystagmus, making it less noticeable.

Question 17

How long does the symptoms in Vestibular Neuronitis last for?

Answer 17

Acute severe symptoms usually last for 2-3 days, but will gradually recover over 2-6 weeks.