What are the distinguishing clinical presentations of vestibular neuritis (VN) versus Meniere's disease (MD)?

From the Guidelines

Vestibular neuritis and Meniere's disease can be differentiated based on their distinct clinical features, with vestibular neuritis typically presenting with sudden, severe vertigo lasting days to weeks without auditory symptoms, and Meniere's disease presenting with recurrent episodes of vertigo lasting 20 minutes to several hours accompanied by fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The key distinguishing features between the two conditions are the presence of auditory symptoms in Meniere's disease and the pattern of vertigo episodes - single prolonged episode in vestibular neuritis versus recurrent shorter episodes in Meniere's disease 1.

Clinical Presentation

• Vestibular neuritis: sudden, severe vertigo lasting days to weeks, accompanied by nausea, vomiting, and horizontal nystagmus, without auditory symptoms 1.
• Meniere's disease: recurrent episodes of vertigo lasting 20 minutes to several hours, accompanied by fluctuating sensorineural hearing loss, tinnitus, and aural fullness in the affected ear 1.

Diagnosis

Diagnosis is based on clinical history and physical examination, with audiometric testing and imaging studies used to rule out other causes of vertigo and hearing loss 1.

Treatment

Treatment for vestibular neuritis includes vestibular suppressants, antiemetics, and early vestibular rehabilitation exercises, while Meniere's disease management includes low-salt diet, diuretics, and avoiding caffeine and alcohol, with vestibular suppressants and antiemetics used during acute attacks 1.

Management

Persistent cases of Meniere's disease may require intratympanic gentamicin or surgical interventions, and clinicians should counsel patients on the natural history, measures for symptom control, treatment options, and outcomes 1.

In summary, the clinical presentation, diagnosis, and treatment of vestibular neuritis and Meniere's disease are distinct, and accurate diagnosis and management are crucial to improve quality of life and reduce morbidity and mortality.

From the Research

Presentation of Vestibular Neuritis vs Meniere's Disease

The presentation of vestibular neuritis and Meniere's disease can be distinguished by their clinical features.

• Vestibular neuritis is characterized by:
  • Abrupt true-whirling vertigo lasting for more than 24 hours 2
  • No presence of cochlear symptoms and other neurological symptoms and signs 2
• Meniere's disease, on the other hand, is characterized by:
  • Episodic vertigo, tinnitus, hearing loss, and aural fullness 3
  • Vertigo episodes can be debilitating and affect the patient's quality of life 3

Diagnostic Evaluation

Diagnostic tests such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test can help diagnose vestibular neuritis 2.

• In Meniere's disease, diagnostic tests may include:
  • Audiometry to assess hearing loss 3
  • Electrocochleography to evaluate the function of the cochlea and vestibular system 3

Treatment Options

Treatment options for vestibular neuritis include:

• Symptomatic therapy, such as vestibular suppressants and antiemetics 2
• Specific drug therapy, such as steroid therapy, antiviral therapy, and vasodilator therapy 2, 4
• Vestibular rehabilitation therapy to improve vestibular compensation 2, 5
• Treatment options for Meniere's disease include:
  • Oral diuretic medications, such as isosorbide and hydrochlorothiazide, to reduce vertigo episode frequency 3
  • Betahistine to improve hearing and reduce vertigo episodes 4, 3