trainee · Clinical case

Case 3 — Episodic vertigo with fluctuating hearing loss

Vignette
A 47-year-old woman has had six episodes over the past year of spinning vertigo lasting 2 to 5 hours, accompanied by right-sided aural fullness, low-pitched tinnitus, and reduced hearing in the right ear. Between episodes she is well, though hearing remains somewhat reduced on the right. Caloric testing in clinic shows a 42% canal paresis on the right. vHIT is performed during a stable interictal week.

Six-canal vHIT

0100200R latg=0.860100200L latg=0.940100200R antg=0.820100200L antg=0.880100200R postg=0.800100200L postg=0.86

Audiogram

2505001k2k4k8k020406080100120Frequency (Hz)Hearing level (dB HL)○ right× left

What is the most likely diagnosis given the dissociation between calorics and vHIT?

References

  1. Cordero-Yanza JA, Arrieta Vázquez EV, Hernaiz Leonardo JC, Mancera Sánchez J, Hernández Palestina MS, Pérez-Fernández N. Comparative study between the caloric vestibular and the video head impulse tests in unilateral Meniere disease. Journal of Neurology 2019;266 (Suppl 1):S96–101.
  2. Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A. Diagnostic criteria for Meniere disease. Journal of Vestibular Research 2015;25:1–7.
← All cases