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Pathophys and Cause ⬇

Cause:Idiopathic

Pathophys:

Endolymphatic hydrops in scala media causes increased pressure in scala media. Probably due to diminished resorption causing organ of corti damage and semicirc canal involvement

Attack probably represents an endolymphatic rupture with mixing of endo- and perilymph; endolymph has an intracellular ionic content

Epidemiology ⬆ ⬇

Onset usually in 5th decade

Signs and Symptoms ⬆ ⬇

Sx:

Si:Decreased auditory discrimination, in contrast to conductive losses; recruitment

Complications ⬆ ⬇

Complete hearing loss in affected ear

Lab and Xray ⬆ ⬇

Lab:Audiometry shows sensorineural loss without air-bone gap. Recruitment of sound so that loudness increases abruptly with slight increase in decibel level, ie, abnormally loud above their abnormally high threshold; this is the distinguishing feature between cochlear (Ménière's, presbycusis) and retrocochlear disease

Treatment ⬆

Rx:

Salt, caffeine, and alcohol restriction

Medications:

  • Benzodiazepines in low dose, tapered to minimally effective dose, like diazepam (Valium) 2 mg po tid (never more) initially then tapered over 1-2 wk to 2 mg qd; or lorazepam (Ativan) 1 mg sl/po
  • Antihistamines (Benadryl)
  • Antivertigo drugs (scopolamine, meclizine [Antivert], dimenhyrdinate [Dramamine], phenothiazines)
  • Diuretics prophylactically, eg, thiazides
  • Streptomycin, perhaps, 2-3 gm im qd to produce bilateral nerve damage in 10-20 d, unused now

Surgical: rarely need; labyrinthectomy through middle ear if hearing already gone there; endolymphatic saccule to subarachnoid space shunt; sacculotomy; 8th nerve section