Labyrinthitis Vestibular Abnormalities and Menieres Disease

A comprehensive review of these topics is beyond the scope of this chapter but should be considered when evaluating any patient with dizziness. Patients with the abrupt onset of a single episode of vertigo that gradually resolves over several days often have labyrinthitis or vestibular neuronitis, usually distinguished clinically by the presence or absence of hearing changes. Patients with labyrinthitis usually experience hearing changes, whereas those with vestibular neuronitis do not. A viral infection is the usual cause in younger patients while infarction becomes more likely in the older adult. Older-adult patients may recover more slowly and experience feelings of imbalance for several months. Treatment during the symptomatic period may include vestibular rehab exercises and pharmacologic agents such as meclizine, promethazine, or low-dose benzodiazepine (e.g., lorazepam). Meniere's disease should be suspected when an older adult reports recurrent episodes of vertigo, tinnitus, gradual development of low-frequency hearing loss, and in some cases ear fullness before onset of vertigo.

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