A patient with endolymphatic hydrops refractory to shunt surgery.

A 49-year-old woman came to the office with a 7.5-year history of symptoms, which had begun 6 weeks after the birth of a child. She had noticed that while she was breastfeeding her infant, she began to experience right aural fullness and tinnitus, which were intermittent at first but which had become constant in 3 weeks. One year later, she experienced a single episode of rotary vertigo, which was accompanied by nausea and vomiting. Six months later, just after the woman had experienced a spontaneous abortion, the vertigo returned; this time her spells were frequent and severe.

Her condition worsened to the point that surgery was performed to place an endolymphatic shunt. However, she experienced another spell just 2 weeks following this surgery, and her episodes of vertigo continued--12 in all over the succeeding 3 years. During that time, she had been prescribed diazepam and was placed in a vestibular rehabilitation program.

By the time she came to the office, her dizziness was almost constant. Her episodes were intensified by motion, and they were accompanied by nausea and vomiting. She had a constant, fluctuating tinnitus in the right ear, which grew louder during her menstrual period. She noted a progressive loss of hearing in the right ear, along with a constant aural fullness that intensified as the dizziness did.

Electronystagmography revealed no spontaneous, positional, or neck torsion nystagmus. The alternate binaural bithermal stimulus showed an 18% reduced vestibular response (RVR) to the right and a 21% directional preponderance to the right. The simultaneous binaural bithermal stimulus revealed a type 2 RVR to the right. These findings were in keeping with the patient's clinical history of right endolymphatic hydrops that was unresponsive to endolymphatic shunt surgery.

From Neurotologic Associates, P.C., New York City.