Meniere’s disease

This condition is characterized by recurrent attacks of the three symptoms-vertigo, tinnitus and deafness. It is associated with a dilatation of the endolymph system of unknown cause.


The sudden, unprovoked attacks of vertigo with vomiting and loss of balance last from minutes to hours. Tinnitus and deafness accompany an attack but may be overshadowed by the degree of vertigo. The attacks are recurrent over months or years. Ultimately deafness develops and the vertigo ceases.


Nystagmus often accompanies an attack. Sensorineural deafness may be found.


Medical treatment with vestibular sedatives (e.g. cinnarizine or prochlorperazine) is unsatisfactory. Each attack is, however, self-limiting. Betahistine 8 mg three times daily is sometimes helpful. Recurrent severe attacks may require surgery (e.g. ultrasound destruction of the labyrinth or vestibular  nerve section).

Vestibular neuronitis

This common but poorly understood syndrome describes an acute attack of severe vertigo with nystagmus, often with vomiting, but without loss of hearing. It is believed to follow or accompany viral infections that affect the

The disturbance lasts for several days or weeks but is self-limiting and rarely recurs. Treatment is with vestibular sedatives. The condition is sometimes followed by benign positional vertigo. Very similar symptoms may be caused by demyelination or vascular lesions within the brain stem.

Benign positional vertigo and positional nystagmus

Positional vertigo is vertigo precipitated by head movements, usually into a particular position. It may occur when turning in bed or on sitting up. The vertigo is transient, lasting seconds or minutes.

Vertigo can be produced by moving the patient’s head suddenly (Hallpike’s test). There is a latent interval of a few seconds, followed by nystagmus. The syndrome of benign positional vertigo sometimes follows ‘vestibular neuronitis’, head injury or ear infection. It usually lasts for some months. There are no sequelae, although the condition sometimes recurs. Treatment is with vestibular sedatives.

Positional nystagmus (and vertigo) that is without a latent interval and does not fatigue is occasionally seen with neoplasms of the posterior fossa.

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