Clinical Features and Management of Drop Attacks in Menière's Disease. Special Emphasis on the Possible Occurrence of Vertigo After the Drop Attacks. Issue 8 (September 2021)

• Record Type: Journal Article
• Authors: Lelonge, Yann; Karkas, Alexandre; Peyron, Roland; Reynard, Pierre; Convers, Philippe; Bertholon, Pierre
• Is Part Of: Otology & neurotology. Volume 42:Issue 8(2021)
• Publication Date: 2021-09
• Subjects: Delayed vertigo -- Drop attacks -- Down beating nystagmus -- Menière's disease -- Otolithic catastrophe -- Tumarkin crisis; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000003174
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Introduction: Tumarkin first described drop attacks (DA) in patients with a peripheral vestibular syndrome and speculated the role of a mechanical deformation of the otolith organs. We emphasized on the possible occurrence of vertigo/dizziness after a DA. In the light of the oculomotor examination of one patient right after the DA, we discussed on the mechanisms. We also described the management of DA. Material and Method: This study included patients with definite Meni[REPLACEMENT CHARACTER]re's disease (MD) and at least one DA without associated neurological symptoms. Patients with vertigo/dizziness after the fall were not excluded. Results: Fifteen patients with MD complained of DA that was complicated either by severe head trauma (n = 1) or various fractures (n = 4). Seven patients complained of vertigo/dizziness after the DA. In one patient, DA occurred in the waiting room with a vertical illusion of movement immediately after the fall and a predominant down beating nystagmus that later changed direction. Follow up was favorable in all patients after oral medication alone (n = 7), chemical labyrinthectomy (n = 7) or vestibular neurotomy (n = 1). Conclusions: We suggest that a subset of patients with MD can complain of vertigo after a DA. We conclude on the possible occurrence of a vertical mainly down beating nystagmus in MD. Since this latter nystagmus is likely related to a semicircular canal rather than an otolith dysfunction, we discuss on the mechanisms of DA followed by vertigo/dizziness. Due to the risk of trauma in DA, chemical labyrinthectomy is a reasonable and effective option although spontaneous remission is possible. Abstract : Supplemental Digital Content is available in the text