I. Pathophysiology and
- Caused by fluid accumulation in the labyrinth
- Symptoms are intermittent and involve combination of (vertigo
+ tinnitus), usually with onset over minutes and lasting several
- Sensorineural hearing loss is often also present during episodes
- Hearing loss usually affects low frequencies initially, though
over time can include middle and high frequencies.
- Can start with just vertigo or just hearing loss and acquire the
other symtpoms over the course of a year or so
- Over time, acute attacks and vertigo tend to decline in
frequency, but hearing loss and tinnitus often become permanent.
- Usually starts as unliateral; 50% become bilateral
- MRI with and w/o contrast can help r/o acoustic neuroma
- Low-sodium diet and diuretics often recommended but there is
limited data to support their effectiveness
- "Vestibular suppressants" can help during an acute episode, e.g.
meclizine, lorazepam, clonazepam, scopolamine, dimenhydrinate.
- "Labyrinthectomy" by chemical (intratympanic gentamicin) or
surgical means can be effective but cause irreversible hearing loss on
the treated side.
- Hearing aids or cochlear implants if needed for hearing loss
(Sources include Core Content Review of Family Medicine, 2012)