Two Cases of Ménière’s Disease Associated with Persistent Postural-Perceptual Dizziness

Abstract

Persistent postural-perceptual dizziness (PPPD) is new conception published by the Barany Society in 2017. There are five diagnostic criteria for PPPD. The main symptom is continuous dizziness for more than three months, that is not explained by other diseases. The symptom is exacerbated by an upright position, active or passive movement, and moving or complex visual stimuli. The appearance of a balance disorder (e.g., vertigo) precedes PPPD. It is possible that PPPD patients can be handicapped in their activities of daily living (ADL).

We report herein on two cases of Ménière’s disease associated with PPPD. The affected patients were in the interval stage of Ménière’s disease, and had no vestibular dysfunction. No abnormality was seen on head and cerebellopontine angle MRI. However, the patients had been experiencing both a floating and a rotating sensation over a prolonged period. Their symptom was exacerbated by an upright position, active or passive movement, and moving or complex visual stimuli. The floating sensation made them inactive. We distinguished PPPD from Ménière’s disease, and correctly diagnosed PPPD. The reported treatments of PPPD are medication, rehabilitation, and cognitive behavior therapy, and cognitive behavior therapy was effective for both patients.

These two Ménière’s disease cases indicated the possibility that the Ménière’s disease may sift to PPPD during the interval stages, and it requires a different strategy of treatment compared with Ménière’s disease-­related symptoms.