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Industry: Email Alert RSS FeedSpontaneous vertigo and headache: Endolymphatic hydrops or migraine? - Original Article
Ear, Nose & Throat Journal, Dec, 2001 by Thomas E. Boismier, Michael J. Disher
Disability. Those in both the EH and MAV groups registered substantial declines in mean disability scores (figure 2). The mean disability score was unchanged in the noncompliant group.
Second follow-up. We telephoned each of the 20 compliant patients again 6 months after each initial post-treatment survey, and we were successful in contacting 11 patients in the EH group and two in the MAV group. Mean symptom severity (table 1) and disability (figure 3) scores continued to show improvement over pretreatment levels.
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The EH and MAV groups were not large enough to statistically evaluate group differences, but several trends became apparent. Notable differences were observed in terms of age, family history of migraine, history of head trauma, the duration of the vertigo attacks, and the onset of symptoms (table 2). The results of objective tests suggested trends toward group differences with respect to the presence of static nystagmus, postural control abnormalities, caloric weakness, rotation asymmetry, and the rotation phase/time constant (figure 4). There was no incidence of significant asymmetrical hearing loss in either the EH or MAV group; all audiograms revealed either normal sensitivity or bilateral sensorineural hearing loss consistent with presbyacusis.
Discussion
The results of our study suggest that for patients who have an equivocal differential diagnosis of endolymphatic hydrops versus migraine-associated vertigo, a stepwise approach to treatment is appropriate. This method entails initial treatment for endolymphatic hydrops followed by treatment for migraine-associated vertigo for those who do not respond. The fact that the three noncompliant patients in our study did not experience any improvement suggests that treatment is indeed effective and that improvement is not simply a function of the passage of time.
The trends we noted in the differences between the EH and MAV groups might serve as diagnostic guides. Although these trends could not be statistically validated because of the small initial sample and the large degree of attrition inherent in this type of study, our results do suggest that there are demographic and clinical factors that might merit further investigation as possible diagnostic predictors (table 2). For example, these trends suggest that patients with migraine-associated vertigo are younger and have much shorter vertigo attacks than those with endolymphatic hydrops. Patients with migraine-associated vertigo might also be more likely to have a history of head injury.
The results of objective testing also suggest possible predictive trends (figure 4). Patients with endolymphatic hydrops might be more likely to have spontaneous, positional, and post-head-shaking nystagmus; abnormal postural control; and caloric weakness. Those with migraine-associated vertigo might be more likely to exhibit rotation abnormalities.
Further study involving a larger group of patients is warranted. Given the small percentage of patients (6.0%) in our center who were candidates for this study and the large number lost to follow-up as the study progressed, a multi-institutional study might be required in order to recruit a sufficient number of patients. Those patients who do not comply with treatment might be used as a de facto control group.
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