Electronystagmographic Findings in a Case of Lermoyez's Syndrome

Case eport
Auris·Nasus·Larynx (Tokyo) 21, 118-121 (1994)
Electronystagmographic Findings in a Case of Lermoyez's Syndrome
Yi-Ho YOUNG, M.D. and Chih-Hsiu Wu, M.D.
Liang. F .40
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1992.8.26.
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Department of Otolaryngology, National Taiwan University, Taipei, Taiwan
A 40-year-old female patient with Lermoyez's syndrome is presented. Prior to the vertiginous attack, right low-tone hearing loss and tinnitus were noted. During the vertiginous attack, spontaneous nystagmus was directed to the right (iesioned) side, with improvement of cochlear symptoms. After the vertiginous attack, nystagmus was positional rather than spontaneous, and was directed to the left (opposite) side, with the subsidence of cochlear symptoms. One week later, follow-up audiometry revealed bilateral normal hearing. Lermoyez's syndrome is considered to be a variant of Meniere's disease. 1,2 Many studies of Lermoyez's syndrome have been from an audiological perspective, emphasizing the occurrence of endolymphatic hydrops by means of electrocochleography/,4 with little attention towards vestibular function. In patients with an acute attack of Meniere's disease, change of direction of spontaneous nystagmus is observed5; however, there is no report of whether it also occurs in cases of Lermoyez's syndrome. Recently, we encountered a patient with Lermoyez's syndrome, and recorded the evolution of nystagmus before, during, and after the vertiginous attack. This paper discusses this syndrome from the vestibular perspective.
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Fig. 4. Audiogram, 10 days after vertIgmous attack, reveals bilateral normal hearing.
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1992 .8.27.
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Fig. 3. Audiogram and ENG findings after vertiginous attack. There is bilateral hearing improvement with positional nystagmus beating to the left side.
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1992. 8.26.
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Fig. 2. Audiogram and ENG findings during vertiginous attack. Improving hearing of both ears with spontaneous nystagmus beating to the right side are observed.
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Fig. 1. Audiogram and ENG findings before vertiginous attack. Bilateral low-tone hearing loss ( especially in the right ear) and direction preponderance to the left side of optokinetic after-nystagmus ( arrow) are seen.
Auris·Nasus·Larynx (Tokyo) Vol. 21 (1994)
119
Liang, F, 40
I I I
I I I I
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1992.8.27.
12oi'sec
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CASE REPORT
The patient was a 40-year-old female, a physician at our hospital. She had been previously diagnosed as having Meniere's disease of the right ear, and had suffered three vertiginous attacks in the past three years. On August 24, 1992, she noted a sensation of fullness, tinnitus, and hearing loss in both ears on waking in the morning. The right ear was much more severely affected than the left. Audiometry showed right low-tone hearing loss, and examination of eye movement revealed directional preponderance of optokinetic after-nystagmus beating to the left side (Fig. 1). The tentative diagnosis was acute low-tone hearing loss of the right ear and she was admitted for further investigation and management. She experienced two further attacks of vertigo on the night of August 25 and the early morning of August 26, with spontaneous nystagmus directed to the right (lesioned) side. Audiometry and electronystagmography (ENG) were performed on the morning of August 26, and showed bilateral improvement of hearing, and spontaneous nystagmus beating to the right (lesioned) side (Fig. 2). However, the bothersome tinnitus and sensation of fullness in the ear subsided, and she felt much improvement of her hearing although she still experienced vertigo and remained in her bed. On the morning of August 27, she could walk about the ward with no imbalance. Repeated audiometry showed further improvement of hearing bilaterally. No spontaneous nystagmus was visible. However, positional nystagmus was present in the right lateral and left lateral position with the direction beating to the left (opposite) side (Fig. 3). There was no