Ease Into Prep with a PANCE^® Question of the Day

The correct answer is C. This patient has Meniere disease, which is characterized by tinnitus, vertigo, and progressive hearing loss. It is thought to be related to a degeneration of the vestibular and cochlear hair cells, or by overproduction or impaired resorption of endolymph in the middle ear. The treatment includes bed rest, a low-salt diet, and diurectics along with vestibular suppressants such as meclizine (Antivert) or antiemetics such as dimenhydrinate (Dramamine) or promethazine (Phenergan).

Benign paroxysmal positional vertigo (choice A) is characterized by paroxysmal vertigo and nystagmus. It is brought on by certain changes in position. Hearing loss is not present. The cause is idiopathic.

Benign recurrent vertigo (choice B) and vestibular neuronitis (choice E) are two names for the same syndrome, which is characterized by the sudden onset of vertigo, nausea, and vomiting. There is no change in hearing.

Toxic labyrinthitis (choice D) presents with vertigo. It is due to medications and alcohol. Aminoglycosides are among the most common drug-related causes.

PEARL: Meniere disease affects both the auditory and vestibular systems, thus causing sudden onsets of vertigo, progressive hearing loss, tinnitus, and a feeling of fullness in the ear. Diagnosis is made by clinical history and audiologic tests (unilateral sensorineural low frequency hearing loss occurs initially). Meniere may develop as a result of overproduction or impaired resorption of endolymph in the inner ear. To meet the criteria for diagnosis, it needs to have a pattern of recurrence of symptoms along with the progressive hearing loss.