A 52-year-old man presents to his primary care physician with complaints of recurrent episodes of severe vertigo, hearing loss in his left ear, and a constant ringing sound in the same ear. He also reports a sensation of fullness in his left ear and episodes of nausea and vomiting during the vertigo attacks. These symptoms have been occurring intermittently over the past several months. He has taken meclizine without improvement in his symptoms. Past medical history is significant for hyperlipidemia for which he takes atorvastatin. Vital signs are within normal limits. Physical examination reveals that the external auditory canals are clear and the tympanic membranes appear normal. The remainder of the physical examination, including a neurologic examination and Dix-Hallpike maneuver, is unremarkable.
D) Meniere disease
Meniere disease presents with hearing loss accompanied by severe vertigo, tinnitus, a sensation of ear fullness, nausea, and vomiting. These symptoms are characteristic of this inner ear disorder. Acute treatment includes vestibular suppressants (benzodiazepines or anticholinergics such as scopolamine) and antiemetics to help with the nausea and vomiting. Lifestyle modifications such as salt restriction, limited caffeine intake, and limited alcohol consumption should be continued indefinitely. Vestibular rehabilitation is important, and pharmacotherapy includes betahistine and diuretics.
Answer choice A: Acoustic neuroma, is incorrect. Acoustic neuroma typically presents with unilateral hearing loss and tinnitus, but vertigo is less common and usually not as severe as in Meniere disease.
Answer choice B: Benign paroxysmal positional vertigo (BPPV), is incorrect. BPPV presents with brief episodes of vertigo triggered by changes in head position, without hearing loss, tinnitus, or ear fullness.
Answer choice C: Labyrinthitis, is incorrect. Labyrinthitis can cause vertigo and hearing loss, but it is usually associated with a preceding upper respiratory infection and does not typically present with a sensation of ear fullness.
Answer choice E: Vestibular neuritis, is incorrect. Vestibular neuritis presents with vertigo and nausea but does not typically cause hearing loss or tinnitus.
Key Learning Point
Meniere disease presents with hearing loss accompanied by severe vertigo, tinnitus, a sensation of ear fullness, nausea, and vomiting.
