Monday, May 4, 2009


A 30 year old woman presents with episodic dizziness. She describes this as a rotary spinning or rocking sensation. She cannot identify the triggers, but they last from 20 minutes to 20 hours and involve nausea, vomiting, and aural fullness. This has been going on for months but she says that she's fine for long periods of time. She also complains of a low pitch buzzing, like "listening to a seashell" or "machinery." Ear exam is shown below:

An is the annulus fibrosis, Lpi is the long process of the incus, Um is the umbo, Lr is the light reflex, Lp is the lateral process of the malleus, At is the attic (pars flaccida), and Hm is the handle of the malleus. Pretty, isn't it?

You send her for audiometry which shows low frequency sensory loss with normal hearing in the mid frequencies. You rule out multiple sclerosis, TIA, and migraine.

Challenge: What's the diagnosis?

Related Question:
1. What's the "buzzing" called?
2. What does the ear exam show?

Image shown under fair use.

1 comment:

Craig Chen said...


This is Meniere's disease, named for French physician Prospere Meniere, believed to be due to abnormal fluid and ion homeostasis in the inner ear. The pathology of the temporal bone shows endolymphatic hydrops. The triad is episodic vertigo, sensorineural hearing loss, and tinnitus (the "buzzing"). The ear exam shown here is a normal ear exam.

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