A 47-year-old woman has dozens of very brief spinning episodes each day, each lasting a few seconds, triggered by turning her head, with normal audiometry and a normal neurological examination. MRI shows vascular contact at the root entry zone of the eighth nerve. Which treatment is most likely to abolish these spells?
- A Carbamazepine ✓
- B Epley repositioning manoeuvre
- C Intratympanic gentamicin
- D High-dose betahistine
Correct answer: A. Carbamazepine
Explanation
This is vestibular paroxysmia, caused by neurovascular compression of the eighth nerve producing ectopic discharges. It presents with frequent, very brief attacks of seconds' duration, often triggered by head movement, and characteristically responds dramatically to carbamazepine or oxcarbazepine, which also serves as a therapeutic trial. BPPV lasts seconds but is positional and not this frequent. Gentamicin ablates vestibular function in refractory Meniere's disease, and betahistine has no role here.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.