A 42-year-old man has recurrent attacks of rotatory vertigo each lasting about three hours with vomiting, preceded by a sense of fullness in the left ear and accompanied by roaring tinnitus. Between attacks he feels well. Audiometry shows mild low-frequency sensorineural loss on the left that partially resolved after the last attack. The underlying pathological basis of this condition is:
- A Perilymph fistula through the round window
- B Endolymphatic hydrops due to impaired resorption by the endolymphatic sac ✓
- C Demyelination of the eighth nerve at the cerebellopontine angle
- D Ischaemic infarction of the vestibular labyrinth
Correct answer: B. Endolymphatic hydrops due to impaired resorption by the endolymphatic sac
Explanation
The combination of episodic vertigo lasting minutes to hours, fluctuating low-frequency sensorineural loss, roaring tinnitus and aural fullness defines Meniere's disease. Its basis is distension of the membranous labyrinth by excess endolymph (endolymphatic hydrops), attributed to defective absorption by the endolymphatic sac; rupture of the membranes triggers attacks. A perilymph fistula typically follows trauma, straining or barotrauma and gives sudden loss, not recurrent stereotyped spells.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.