Pathway of Sound Reception

DISORDERS OF THE VESTIBULOCOCHLEAR NERVE AND SYSTEM

Vestibular

Ménière disease is an idiopathic process characterized by bouts of episodic vertigo, fluctuating but eventually progressive sensorineural hearing loss, tinnitus, and a sensation of aural fullness. Vestibular symptoms predominate especially early, and chronic imbalance may eventually ensue. Ménière disease is felt to be secondary to an imbalance of the inner ear’s endolymph. Bilateral Ménière disease may have an autoimmune basis. Although Ménière disease is often associated with hearing loss and ear fullness, vestibular neuritis in contrast is characterized by prolonged vertigo without hearing loss. Benign paroxysmal positional vertigo (BPPV) is caused by errant otolith debris lodging into the semicircular canals and leading to overstimulation with head movement. Upper respiratory and otologic infections, head trauma, and sustained unusual head postures are described triggers in many cases. Bedside maneuvers and vestibular rehabilitation help reposition errant otolith debris and reestablish equal tonic vestibular input (e.g., canalith repositioning or Epley maneuver).

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