Paper in Laryngoscope
  • Manzari L, MacDougall HG, Burgess AM, Curthoys IS (2013). New, Fast, Clinical Vestibular Tests Identify Whether a Vertigo Attack is Due to Early Meniere’s Disease or Vestibular Neuritis. Laryngoscope, 123 (2), 507-511.

    ABSTRACT
    When a patient arrives at a clinic with an acute attack of vertigo, a major question facing the clinician is what is the cause of this attack? Is it due to early Meniere’s disease (MD) or due to vestibular neuritis (VN)? Both cause severe attacks with vertigo and nystagmus, but the treatment and therapeutic progression and the outcomes for these two causes are entirely different. How is it possible to distinguish between them? The history may be indefinite. The direction of spontaneous nystagmus can be misleading because in some early MD cases the quick phase of the nystagmus beats toward the affected ear.1,2 Caloric testing gives evidence about the level of horizontal canal function, but the variability of the caloric test is high and giving a caloric test to a patient in the midst of a major attack of vertigo is difficult and distressing for both the patient and the clinician, and many such patients refuse to undergo a caloric test, or worse still, do not complete the test. Here we report the results of two patients with very similar vertigo attacks to show how, by applying new clinical tests, it is possible to distinguish simply and quickly between an attack due to early MD as opposed to VN in a way that is fast and not distressing for the patient (or the clinician).