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in patients without hearing and has been reported in improve quality of life in 98%
of patients [160]. The procedure is most commonly performed via a transmastoid
exposure but can be done via a transcanal approach.
H. Sakano and B. T. Crane
Vestibular Therapy
Vestibular rehabilitation is primarily used for postoperative recovery of Menière’s
patients who have undergone ablative procedures.
Chapter Summary
Menière’s disease is characterized by episodic attacks of vertigo, hearing loss,
tinnitus, and aural fullness. Much progress has been made since Prosper
Menière’s rst description of the disease as a condition attributed to the inner
ear. There are now dened diagnostic criteria, histopathological as well as
imaging evidence of endolymphatic hydrops, and tests that measure inner ear
function with variable sensitivity and specicity. Treatments now include
medications to improve the severity of symptoms and delay hearing loss, and
there has been continued evolution of surgical treatments to alleviate vertigo.
However, the exact cause of the development of Menière’s disease and endo-
lymphatic hydrops remains elusive, and therefore, the cure for it is yet to be
discovered.
Quizzes
1. Most patients with Menière’s disease have a family history of the condition (T/F).
2. Endolymphatic sac surgery has an efcacy that is well supported by clinical tri-
als (T/F).
3. For the case study example where you suspect Menière’s disease, what kinds of
objective testing could help support the diagnosis?
4. For the case study example, what are potential treatments you can offer given the
recent increased frequency of attacks despite being on diuretic medication?
Answers
1. False. Family history is only present in 10–20% of case.
2. False. Although randomized controlled trials were done, the efcacy was similar
to sham surgery.
3. Caloric testing may yield asymmetry with weakness of the affected ear.
Electrocochleography may yield abnormally elevated SP/AP ratios >0.5.
Reduced amplitudes may be seen on cVEMP on the affected side.
4. Oral or intratympanic steroid injections may be offered. If despite this she con-
tinues to experience frequent, debilitating symptoms, ablative procedures such
as intratympanic gentamycin or labyrinthectomy may be discussed. The type of
ablative treatment may be swayed by the degree of existing hearing loss.
4 Menière’s Disease
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H. Sakano and B. T. Crane
Further Reading
Baloh RW.Prosper Meniere and his disease. Arch Neurol. 2001;58(7):1151–6.
Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, et al. Clinical
practice guideline: Meniere’s disease executive summary. Otolaryngol Head Neck Surg.
2020;162(4):415–34. https://doi.org/10.1177/0194599820909439.
Chung JW, Fayad J, Linthicum F, Ishiyama A, Merchant SN.Histopathology after endolymphatic
sac surgery for Meniere’s syndrome. Otol Neurotol. 2011;32(4):660–4. https://doi.org/10.1097/
MAO.0b013e31821553ce.
Chapter 5
https://t.me/medicina_free
Vestibular Neuritis
T.LoganLindemann andPamelaC.Roehm
Introduction
Vestibular neuritis, also referred to as vestibular neuronitis, labyrinthitis, and acute
unilateral peripheral vestibulopathy (AUPVP) [1], is an acute vestibulopathy of the
peripheral vestibular system. It is one of the most common causes of peripheral
vertigo, following benign paroxysmal positional vertigo (BPPV) [2, 3]. Vestibular
neuritis may follow a nonspecic viral illness, although symptoms may present
several weeks following the initial illness. Patients complain of a rapid-onset vertigo that lasts for days and then resolves over the next few weeks. Residual dizziness
and imbalance may continue for several months. While vestibular neuritis is benign
and most often associated with complete resolution of symptoms, it can be very
debilitating for patients during the acute phase.
T. L. Lindemann
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
e-mail: logan.lindemann@temple.edu
P. C. Roehm (
Division of Otolaryngology, St. Christopher’s Hospital for Children,
Philadelphia, PA, USA
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
B. T. Crane et al. (eds.), Disorders of the Vestibular System,
https://doi.org/10.1007/978-3-031-40524-2_5
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