A 42-year-old woman comes to the office to discuss dizziness. She has a 6-month history of episodic bouts of a "spinning sensation" associated with nausea and ringing in her left ear. The patient also has difficulty hearing while holding her phone to the left ear, although hearing in her right ear is normal. The dizziness improves spontaneously and she feels "fine" between episodes. Past medical history is notable for hypothyroidism, for which she is on thyroid replacement therapy, and endometriosis, which led to a hysterectomy at age 38. The patient works as a supermarket manager. She does not use tobacco or drink alcohol. The patient's condition is most likely the result of which of the following?

Question

A 42-year-old woman comes to the office to discuss dizziness.  She has a 6-month history of episodic bouts of a "spinning sensation" associated with nausea and ringing in her left ear.  The patient also has difficulty hearing while holding her phone to the left ear, although hearing in her right ear is normal.  The dizziness improves spontaneously and she feels "fine" between episodes.  Past medical history is notable for hypothyroidism, for which she is on thyroid replacement therapy, and endometriosis, which led to a hysterectomy at age 38.  The patient works as a supermarket manager.  She does not use tobacco or drink alcohol.  The patient's condition is most likely the result of which of the following?

Quizplus · Accepted Answer

11ec160b_3aac_633e_9249_2fbf8b7da089_MD0001_00 This patient has Ménière disease, a disorder of the inner ear characterized by increased volume and pressure of endolymph (endolymphatic hydrops) that is thought to be due to defective resorption of endolymph. The resultant distension of the endolymphatic system causes damage to the vestibular and cochlear components of the inner ear. Ménière disease is characterized by the following triad: (Choice A) Multiple sclerosis (MS) is characterized by patchy demyelination in the central nervous system that varies over time. The presentation of MS is highly variable and may resemble Ménière disease, but most patients will have additional, extra-auditory symptoms (eg, visual symptoms, sensory disruptions). (Choice C) Labyrinthitis is inflammation of the vestibular nerve that causes acute-onset vertigo, nausea, and vomiting. It usually occurs in a single episode following a viral syndrome. (Choice D) A mass lesion at the cerebellopontine angle is most commonly an acoustic neuroma (schwannoma of CN VIII). An acoustic neuroma could cause sensorineural hearing loss, vertigo, and tinnitus, but symptoms would be persistent and progressive rather than episodic. (Choice E) Otosclerosis is an inherited condition seen in middle age. Patients present with conductive hearing loss due to bony overgrowth of the footplate of the stapes. Vertigo does not occur. Educational objective: Ménière disease is characterized by tinnitus, vertigo, and sensorineural hearing loss. Its pathogenesis is related to an increased volume and pressure of endolymph in the vestibular apparatus. __________ References: Endolymphatic hydrops: pathophysiology and experimental models. (http://www.ncbi.nlm.nih.gov/pubmed/20713237)

A 42-Year-Old Woman Comes to the Office to Discuss Dizziness