Review Question - QID 102615

This patient's chronic ear fullness and vertigo-like symptoms suggest a diagnosis of Meniere disease which is associated with sensorineural hearing loss.

The classic constellation of Meniere disease consists of 4 symptoms: episodic dizziness or whirling vertigo, low-frequency sensorineural hearing loss, tinnitus, and a sensation of aural fullness in the ear. These symptoms may or may not develop simultaneously and present in a chronic and undulating fashion. Symptoms are generally not positional and do not resolve on their own. The vertigo episodes of Meniere disease can last hours. Treatment involves salt restriction and diuretics.

Incorrect Answers:
Answer 1: Conductive hearing loss would present with a lateralization on Weber test to the affected ear and bone conduction > air conduction on the Rinne test. This is common in otosclerosis which presents in middle-aged patients with conductive hearing loss that is isolated.

Answer 2: Gradually improving symptoms would be expected in vestibular neuritis (post-infection persistent vertigo without hearing loss that gradually improves) or labyrinthitis (post-infection persistent vertigo with hearing loss that gradually improves). Meniere disease is a chronic syndrome that will not spontaneously resolve.

Answer 3: Positional vertigo describes benign paroxysmal positional vertigo (BPPV) which presents with sudden and severe vertigo with changes in head position. The Dix-Hallpike maneuver can provoke an episode and the treatment involves the Epley maneuver and anticholinergic medications like diphenhydramine.

Answer 5: Vertical nystagmus would be expected in a CNS stroke such as in a vertebrobasilar stroke which may present with sudden onset syncope, vertigo, dysarthria, and dystonia. Suspect this diagnosis in an older patient with many risk factors and sudden onset and persistent symptoms.

Bullet Summary:
Meniere disease presents with intermittent vertigo, ear fullness, and sensorineural hearing loss.