gms | German Medical Science

Introduction: The association of benign paroxysmal positional vertigo (BPPV) with inflammatory conditions such as vestibular neuronitis, head trauma or prior ear surgery has already been reported. In this study, we showed that BPPV can also be diagnosed in patients suffered from Meniere’s disease during vertiginous attack.

Methods: A 55-year-old man, suffering from Menière’s disease in the right ear for a year, presented with a new vertigo attack in the affected ear. On the admission, the patient showed a third degree horizontal nystagmus beating to the right. Audiometry confirmed a severe sensorineural hearing loss in the right ear especially at the low- and high-frequencies. The following day, the patient also complained of short episodes of vertigo related to the head movements; the Hallpike test showed a torsional nystagmus compatible with BPPV of the right posterior semicircular canal. For Meniere’s disease symptoms, the treatment was based on intravenous dexamethasone and vasoactive agent; for BPPV, the Epley’s maneuver was performed.

Results: Within one week of treatment, the symptoms of Meniere’s disease attack were successfully eliminated. The patient was free of BPPV positional vertigo after two sessions of Epley’s maneuver in a period of 10 days.

Conclusions: Certain patients may simultaneously experience BPPV and Meniere’s disease symptoms on the same ear. In this case, it is possible that during the Meniere’s attack, the hydropic distension or rupture damaged the otolithic apparatus leading to release of otoconia debris which migrated to the posterior semicircular canal, resulting in BPPV. Combined therapy addressed to Meniere’s disease and BPPV, including one or two sessions of Epley’s maneuver could be efficacious.