The International Tinnitus Journal


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The International Tinnitus Journal

Official Journal of the Neurootological and Equilibriometric Society
Official Journal of the Brazil Federal District Otorhinolaryngologist Society

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ISSN: 0946-5448


Prediction of Vertigo Recurrences in Meniere's Disease by the Head-Shaking Test

Author(s): Tamio Kamei and Toshiyuki Iizuka

Researchers have observed that when head-shaking nystagmus (HSN) is provoked in patients with peripheral vestibular disorders, usually (in more than 75% of cases) it beats toward the normal or unaffected ear. The reverse of this pattern occurs commonly in patients with Meniere's disease. This finding presumably reflects the changeable pathophysiological state of the labyrinth of Meniere's disease. We retrospectively analyzed clinical records of eight patients who had unilateral Meniere's disease and carne to Gunma University Hospital for consultation in the period from 1984 through 1989. All patients satisfied the following condition: In the period prior to the attacks of vertigo, for which a lO-day period preceding the attack was arbitrarily considered (the forerunning period), HSN reversed its direction, appeared, or disappeared. When HSN showed a biphasic pattern, only the first phase was considered in this present analysis. In the period before the attack, HSN reversed its direction from the normal to the morbid ear five times in four patients, appeared toward the morbid ear in three patients, and disappeared from one beating toward the normal ear before the forerunning period of vertigo attacks in one patient. These findings suggest that the occurrence ofHSN directed to the morbid ear in the recuperation period in Meniere's disease might indicate the impending recurrence of a vertigo attack in a few days. In the present group of patients, vertigo attacks occurred from 6 hours to 8 days (average, 3.2 days) after the observation ofHSN beating toward the morbid ear. In three of these patients, the immediate administration of isosorbide (a hyperosmotic diuretic) in this stage successfully suppressed the recurrence of vertigo attacks.