ENG in a woman with Meniere's syndrome who had a previous endolymphatic sac decompression. (Vestibulology Clinic).

A 52-year-old woman came to the office with a 13-year history of aural symptoms. She initially noted an intermittent fullness in her right ear along with some feeling of instability. Approximately 6 months later, she experienced a full-blown attack of rotary vertigo that lasted approximately 4 hours; after this episode, she said she felt "washed out." The woman subsequently experienced recurrent spells of rotary vertigo, aural fullness, and reduced hearing in her right ear. The aural fullness was intermittent, and her hearing in the right ear fluctuated. Family and friends noted that her symptoms appeared to be seasonal and appeared to be associated with her menstrual cycle.

She had previously undergone a right-ear endolymphatic sac decompression with insertion of silicone sheeting. Following this operation, she had become severely dizzy and required an unplanned 2-day hospital stay. It took her approximately 2 months to get over the dizziness. Sometime after this surgery, she noticed that the hearing loss in her right ear had become significant, although her dizziness appeared to have cleared up.

Approximately 1 year following the sac decompression, the patient began taking birth control pills. For 5 years, she had been relatively free of her aural symptoms. However, at that point, her dose of oral contraceptives was reduced, and she again experienced a dizzy spell. During the next year, she had experienced approximately six major spells. She said that when she felt a spell coming on, she was sometimes able to abort it by taking diazepam. At this same time, she also heard a "seashell" noise in her right ear and a rare noise in the left ear.

At her visit to the author's office, the woman had no useful hearing in her right ear and no hearing loss in her left ear. She said that for the previous 2 months, she had had some feeling of pressure in and around the right ear. Between her dizzy spells, she said she did not feel quite right. Her family history included hearing loss and dizziness. She was currently taking hydrochlorothiazide daily and diazepam as needed.

While performing the sharpened tandem Romberg' s test, she had great difficulty with the right foot forward and mild to moderate difficulty with the left foot forward. Mild nuchal tenderness was present on the right. Audiology revealed normal hearing in the left ear and a moderate to severe sensorineural hearing loss with impaired discrimination in the right.

Electronystagmography detected a direction-changing positional nystagmus, with a left-beating nystagmus in the right lateral position and a right-beating nystagmus in the left lateral position. The alternate binaural bithermal test elicited no response to warm and cool caloric stimuli in the right ear and no response to the warm stimulus in the left. Ice-water stimulus in the right ear produced a 2[degrees]/sec left-beating nystagmus and ice water in the left ear produced an 8[degrees]/sec right-beating nystagmus. These findings were consistent with her long-standing history of Meniere' s syndrome, her dizziness following sac surgery, and the attempt by her efferent system to produce symptomatic relief by suppressing the vestibular function of the opposite ear.

A 5-hour glucose tolerance test elicited a hypoglycemic response of 33 mg/dl at hour 3, and ultrathin computed tomography of the temporal bones showed evidence of inner ear otosclerosis. The patient was placed on a regimen to address her metabolic factors and on a bisphosphonate and calcium carbonate to address her otosclerosis. Six months later, she was free of dizziness and she felt that her hearing in the right ear might be returning.

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