Common_Vestibular

TABLE I
MENIERE'S DISEASE
DIFFERENTIAL DIAGNOSIS and TREATMENT
SYMPTOMS and DIAGNOSES for COMMON VESTIBULAR PROBLEMS
Source: American Family Physician - Volume 55, Number 4 - March 1997
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DX	Whirling Vertigo	Dizziness or Lightheaded	Hearing Loss	Ear Fullness/ Pressure	Positional Component	Tinnitus	Headache	Imbalance	Cognitive Impairment
Meniere's	Yes: episodic	Sometimes	Fluctuating, and classically occurring in the low frequencies	Yes: fluctuating	No	Yes: fluctuating	If present, is usually unrelated	Only during vertiginous episodes	No
BPPV	Yes	Sometimes	If present, is probably unrelated	No	Yes: Dix-Hallpike Testing Confirms the Dx	No	No	Occasional	No
Vetibular Neuronitis	Only in the acute phase at the beginning of the disease	Yes	No	No	No	Sometimes accompanies hearing loss	No	No	No
Viral Labyrinthitis	Only in the acute phase	Yes	Yes	No	No	No	No	Yes: very prominent	No
Presbystasis	Occasional	Yes	If present, is unrelated	No	No	No	No	Yes: very prominent	No
Acoustic Neuroma	Rare	Yes: slowly progressive	Yes: slowly progressive	Sometimes	No	Accompanies hearing loss	No	Yes	No
Vertiginous Migriane	Sometimes	Yes	No	No	No	No	Yes: with migraine aura	No	No
Head Trauma Syndrome	Sometimes	Yes	Sometimes accompanies temporal bone fracture, but is not necessary for dx	NO	Sometimes	Sometimes accompanies hearing loss	Yes	Yes	Yes

Meniere's disease may be the underlying cause of dizziness, which is a common presenting complaint. This disease is differentiated from other causes of dizziness by its classic constellation of four symptoms: dizziness characterized as episodic spinning or whirling vertigo; fluctuating, low-frequency sensorineural hearing loss; tinnitus, and a sensation of fullness in the ear. Because these symptoms may or may not develop or occur simultaneously, a careful history and a complete physical examination are necessary for diagnosis. If Meniere's disease is present but untreated for 10 or more years, hearing may deteriorate as the vertiginous episodes gradually subside. Medical management includes sodium restriction and the avoidance of caffeine, and alcohol. Diuretics, antiemetics, antidepressants and vestibular suppressants may be prescribed, and surgery may be considered in severe, unreponsive cases.