1. Maja Striteska, Jan Mejzlik
Case report – Meniere´s syndrome and BPPV together
Maja Striteska, Jan Mejzlik
1Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic ,
ORL ambulance TINITUS
Pctr. 1 : VHIT in normal range bilat.
Discussion:
First I´d like to discuss – which maneuver to manage in
P-SCC BPPV in MD patients. Epley, which based is much more on gravity principle or Semont which is based much more on dynamic principle?
In our opinion, Semont, when done quickly, is much more pleasant in all types of debris and otoliths due to stronger stream of endolymph going the same way as otoliths and debris.
Although our patient benefited from having done the Semont maneuver, it was an unpleasant surprise that the BPPV maneuver triggered an acute attack of Meniere´s disease.
Abstract:
How to manage BPPV in Meniere´s disease patients? Do they respond to BPPV treatment maneuvers as well as BPPV isolated patients? Are there any special things to focus on in the treatment of Meniere´s disease patients suffering from underlining BPPV?
Key words : BPPV, Benign paroxysmal positional vertigo, Meniere´s disease – syndrome (MD), Semont maneuver, Epley maneuver , canal paresis, acute attack of Meniere , direction of nystagmus, change in nystagmus direction
Introduction:
BPPV and Meniere´s disease are well-known disorders of the inner ear.
In the literature these two diagnoses are mentioned, they can be sometimes found together.
According to some recent studies, the incidence of BPPV in MD patients is about 8-30% (2). In these cases MD often predisposes patients to intractable BPPV, more therapeutic sessions are needed to cure the patient and there is a higher rate of recurrence. (1,2)
Case report:
43 years old man, who met the AAO-HNS criteria for definite MD l. dx., developed an acute attack of MD on 3/16.
After the acute attack has disappeared, he developed typical clinical signs for BPPV. Dix Hallpike was positive on the affected side (MD).
There has been done 3x Epley maneuvers in period of 1 month without any improvement.
On the next visit 4/16, he had no spontaneous nystagmus, We decided to do the Semont maneuver first.
Conclusions:
BPPV in Meniere´s patients is not a rare condition. BPPV in these patients can act as a trigger of an acute attack of MD.
There is a lack of information about the choice between maneuvers in assessing the posterior SCC BPPV- which should be done as most safe and most effective one. In my opinion Epley is much more safe from the point of view of a maneuver being a trigger of an acute attack of MD, Semont is maybe much more effective.
Could the administration of vitamine D as a prevention of the recurrence of BPPV be helpful also in managing the MD and recurrencies of its acute
attacks ?
Pctr.3: Semont Maneuver for treatment BPPV P-SCC l.dx.
10 minutes after the Semont maneuver has been done, the patient has started to feel very dizzy, fullness in the affected ear, III. degree sspontaneous (horizintal) nystagmus to the unaffected side has started.
The treatment with the Semont maneuver triggered the an acute attack of Meniere´s disease.After 1 hour the nystagmus disappeared spontaneously.
The patient visited us on a third day and had no problems with balance. Due to a low threshold of vitamin D we administered him vitamin D as a prevention of BPPV recurrence. Till May 2017 he is without any attack of MD or BPPV, Audiometry decreased in low-freq treshold, VHIT all in a normal range, he refused the caloric test.
Pctr. 1 : VHIT in a normal range bilat.
References:
1. „Intractable Benign Paroxysmal Positional Vertigo in Patients With Meniere's Disease“ -Eric M. Gross MD, Bradford D. Ress MD, Erik S. Viirre MD, PhD, James R. Nelson MD, Jeffrey P. Harris MD,PhD.
2. "Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects." Balatsouras, Dimitrios G., et al. Annals of Otology, Rhinology & Laryngology (2012):
Contact:
Maja Stříteská.
Phone:
Pctr.2a: Audiometry 4/2016
Pctr. 2 : Audiometry – 5/2017