AAO-HNSF Primary Care Otolaryngology Handbook

DIZZINESS

thectomy are some of the surgical options reserved for severe intractable cases. However, they are very rarely employed, as they can be associated with significant risk of hearing loss and other complications. Vestibular Neuronitis and Labyrinthitis Another common cause of vertigo is vestibular neuronitis , which is thought to be caused by inflammation, likely secondary to a viral infec- tion, of the vestibular portion of the eighth cranial nerve. Vestibular neuronitis is frequently associated with recent flu-like symptoms or upper respiratory infection. The patient will usually have sudden onset of room-spinning vertigo that will gradually become less intense over 24–48 hours. During this period, the patient’s hearing is generally unchanged , and nausea with or without emesis is common. Treatment is symptomatic, including vestibular suppressant and antiemetic medi- cations; there is weak evidence to support the use of oral steroids. It may take several weeks for the symptoms to completely resolve. Residual vestibulopathy that persists for months or even years is common and is best managed with vestibular rehabilitation. The presenting symptoms of labyrinthitis can be similar to vestibular neuronitis, although there is often accompanying hearing loss with the former. Both viral and bacterial infections can cause symptomatic inflammation within the labyrinth (inner ear). For example, bacterial infection from acute otitis media may cause a serous labyrinthitis with consequent dizziness and hearing loss. Treatment should be targeted to the source of infection, although this may not always be identifiable. For patients presenting with sudden onset of dizziness and hearing loss with a normal exam, consideration should also be given for treatment of SSHL (see Chapter 3, ENT Emergencies). Ménière’s Disease Ménière’s disease is usually diagnosed by history when patients have the symptom triad of vertigo, hearing loss, and tinnitus . Patients develop intense, episodic vertigo, usually lasting from 20 minutes to 24 hours, associated with fluctuating hearing loss, roaring tinnitus, and the sensa- tion of aural fullness. Even after the episode is over, some hearing loss often remains. (Remember that in BPPV, the vertigo lasts less than one minute and in vestibular neuronitis, the vertigo lasts 24–48 hours.) Although the precise cause of Ménière’s disease has not been unequivo- cally determined, the symptoms are believed to be secondary to a disten- tion of the endolymphatic space within the balance organs of the inner ear (endolymphatic hydrops).

39

www.entnet.org