Vestibular findings in a patient with a history of tinnitus before developing Meniere's disease.

A 44-year-old man came to the office with a 3-year history of intermittent tinnitus in his right ear and intermittent aural fullness bilaterally. The tinnitus and fullness did not always occur simultaneously. Initially, his episodes of tinnitus were brief, and at one point they had disappeared for a year. He characterized the ringing as a medium- to high-pitched tone that had recently become constant. The aural fullness remained intermittent. He also reported that fluctuating hearing loss had been present in the right ear for 1 year, and it became worse in the presence of the tinnitus and aural fullness.

The patient also noted that his balance was not normal and that he would become dizzy when he got up and moved around in the morning. He also felt dizzy when he was under stress and sometimes when he was not in motion. The dizziness would last for a few seconds to a few minutes, and he would occasionally become disoriented and feel the need to lie down.

Results of both a regular and sharpened tandem Romberg's test were normal. The patient's subjective hearing loss in the right ear was confirmed by clinical examination with the 512-Hz tuning fork and by audiometric studies, which revealed a sensorineural hearing loss at 250 and 500 Hz and normal speech testing. Electronystagmography (ENG) detected no spontaneous or positional nystagmus. The alternate binaural bithermal caloric test elicited a significant reduced vestibular response (RVR) right of 32%, and the simultaneous binaural bithermal test showed a type 2 RVR right. ENG vestibular testing also showed an RVR right. Ten months following ENG testing, the patient began to experience typical symptoms of Meniere's disease.

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