the vestibular nerve only on the affected side [10], a sign of a disturbed bloodbrain barrier due to the inflammation.

Treatment

Treatment options consist primarily of vestibular sedatives (e.g. dimenhydrinate, 50–100 mg) [11] in the first 3 days administered in combination with steroids. Kitahara et al. [12] examined 36 patients who were treated for up to 2 years after onset either with or without steroids. Although the treatment onset was rather late, the group on steroids showed a tendency for more improvement. A more detailed study published in 2004 [13] reported on a total of 141 patients who were randomized within 3 days after onset of symptoms to one of four treatment options – placebo, methylprednisolone (starting with 100 mg daily), valacyclovir , or a combination of valacyclovir and methylprednisolone. The main finding of this study was that the groups receiving methylprednisolone had a better final outcome (caloric testing showed about 60% recovery of peripheral vestibular function) after 12 months than the placebo/ valacyclovir groups (36–39%). The combination of valacyclovir and methylprednisolone provided no additional benefit. It has also been reported that patients should be mobilized early to accelerate the recovery of vestibulospinal function [14].

Menière’s Disease

Clinical Aspects

Menière’s disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus that lasts for hours to a few days [11, 15]. Key symptoms of such an attack are a horizontal rotatory nystagmus, postural instability, and nausea/vomiting. The symptoms only rarely include the opposite ear. Only 5 of 101 patients in a 2-year followup developed symptoms in the contralateral ear [16]. In addition to a typical history, the finding of a unilateral hearing deficit on the audiogram and a reduced reaction to caloric vestibular testing also support the diagnosis [15].

Etiology

The cause of Menière’s disease is still not known. It has been shown histopathologically that endolymphatic hydrops and concomitant distortion of the membranous labyrinth can cause Menière’s disease [15]. Other candidates include immunological causes and inflammation. An increased prevalence of migraine has also been described in patients with Menière’s disease [17]. The pathophysiological link between both diseases may be allergic mechanisms [17].