Idiopathic disorder causing vertigo

Aetiology

• Thought to be caused by excess of endolymph within the membranous labyrinth

Pathophysiology

• Current theories suggest the symptoms result from an increase in endolymphatic pressure due to dysfunctioning sodium channels

Clinical features

• Attacks are comprised of a triad of severe paroxysmal vertigo, with sensorineural hearing loss and tinnitus on the affected side
• Vertigo is recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 mins (often lasting hours)
• Change in hearing or tinnitus around the time of the dizzy spell
• Sensation of ear being full

Investigations

• Audiology: typically low frequency sensorineural hearing loss

Management

• Supportive treatment during episodes
• Tinnitus therapy
• Hearing aids
• Lifestyle advice - reducing salt, avoiding chocolate and caffeine, avoiding stress
• There are some medical, injected and surgical options but not much evidence to support effectiveness