DIFFERENTIAL DIAGNOSIS OF PERIPHERAL VESTIBULAR DISORDERS

Differential Diagnosis of Peripheral Vestibular Disorders

PART 4: Advanced Meniere’s Disease

Meniere’s disease is described in more detail in the previous section since it is the prototypical example of a unilateral fluctuating disorder. However, patient’s with advanced Meniere’s disease (a.k.a. "burned out" Meniere’s) will have different complaints from its more active phase. Very frequently after a patient has been affected by Meniere’s for more than 10-15 years, there is a reduction in the acute vertiginous spells. These patients will complain of a more chronic form of imbalance. They have a stable, flat, sensorineural hearing loss and vestibular testing will show a significant reduction in caloric function in the affected ear.

Clinical Presentation

Very often these patients will not give a past history of Meniere’s disease or prior vertiginous attacks unless they are questioned specifically. Their symptoms are similar to the other patients with fixed unilateral deficits – chronic disequilibrium exacerbated by movement. In addition to the vestibular symptoms, these patients will have unilateral hearing loss and tinnitus. The ear fullness noted in active Meniere’s may or may not be present. It has been proposed that the stabilization of symptoms is due to progressive endolymphatic hydrops resulting in fistulization of the endolymphatic space to the perilymphatic space thus eliminating an imbalance in fluid pressure between the endolymphatic and perilymphatic spaces.

Diagnosis

The diagnosis is most easily made in a patient who gives a history of prior active Meniere’s disease who now has stable hearing loss, tinnitus and chronic disequilibrium. It is important to rule out other concomitant vestibular disorder in this setting. In particular, BPPV is common in this patient population and may present with similar symptoms.

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