Caloric test results in a patient with Meniere's syndrome. (Vestibulology Clinic).

A 44-year-old man came to the office with a 5-year history of episodic vertigo with nausea, vomiting, and diarrhea. Some of these episodes lasted as long as 6 hours. At first, his spells occurred approximately once a year, but the patient said he had experienced two within the previous 5 months. The patient had had intermittent aural fullness in the left ear for 10 years. He had undergone nasal septal surgery without relief of the fullness. His spells of vertigo were always preceded by fullness; on other occasions, fullness occurred without subsequent vertigo. The patient was aware of a fluctuation in his hearing in the left ear that was associated with the aural fullness; when the fullness disappeared, his hearing returned to normal. He was also aware of occasional tinnitus in the left ear, but he said it did not appear to be related to episodes of either vertigo or fullness.

The clinical neurotologic examination revealed only that the patient had difficulty performing the sharpened tandem Romberg test. Electrony stagmography revealed a direction-fixed right-beating nystagmus in both the left and right lateral positions. The alternate binaural bithermal test elicited a reduced vestibular response (RVR) on the left of 36% and a directional preponderance of 30% to the right. The simultaneous binaural bithermal stimulus elicited a type 2 response that was consistent with an RVR on the left.

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