Abstract
There are patients who complain of a feeling of fullness in the ear and earache suggestive of acute tubotympanic catarrh or otitis media but in whom the tympanic membranes are entirely free from abnormalities and the Eustachian tubes show no evidence of obstruction on inflation by the eustachian catheter. These patients may show spontaneous nystagmus and deviations of labyrinthine origin on equilibrium tests, evidence of inner ear injury, but nevertheless they say they have never had an attack of vertigo. Audiometric tests reveal a 20 to 40dB elevation of the threshold in low frequency ranges and the hearing loss is not always of the sensorineural type.
We encountered 25 patients with such symptoms during the 1-year period from September 1, 1977 to August 31, 1978. None of these patients had a history of trauma, drug therapy or fever that might have an etiologic relation with the disorder. Many affirmed the presence of stress as a precipitating cause in their past history, while some reported the occurrence of symptoms in repeated episodes. These findings led us to assume that the condition before us, even though lacking in vertigo, is none other than Meniere's disease.
For these patients we prescribed rest, oral steroids and intravenous xylocaine. After 10-14 days of this combined regimen the patients were free from subjective symptoms (a feeling of fullness and otalgia), abnormalities on equilibrium tests (nystagmus and deviation) and perceptive deafness.
Williams advocated the concept of “endolymphatic hydrops without vertigo” and stated that when the process of Meniere's disease is confined to the cochlea. Vestibular symptoms, notably vertigo, may not appear. In our present series, however, the abnormalities on equilibrium tests clearly indicated the presence of a disturbance in the vestibular segment of the labyrinth, and the disease entity in these cases is therefore quite distinct from the one which was designated as “endolymphatic hydrops without vertigo” by Williams. When a patient has no vertiginous attacks in the presence of a lesion in the vestibular segment of the end-organ, the cause of such a failure to develop vertigo must be sought from the psychological aspect.
A psychological test using the Cornell medical index demonstrated that the patients in our present series showed a lesser tendency to neurosis than did Meniere's disease patients in general. This finding may be interpreted as indicating that Meniere's disease patients without vertigo are relatively insensitive to somatic distress, including vertigo.
