Vestibular, otologic, and autonomic symptoms are presented along with the results of audiologic, orthostatic, and autonomic testing. Medical management included fluid loading, dietary changes, exercise, and patient education. Treatment results were analyzed according to the effectiveness in control of vestibular and otologic symptoms. Results were compared with a control group that demonstrated a similar vestibular and otologic presentation without autonomic symptomatology.
RESULTS: All patients described spontaneous, rotational
vertigo, with complete or substantial
vertigo control obtained in 93 (85%) of 110 patients. Postural
vertigo and distinct
lightheadedness were also documented in 53% and 97% of cases, respectively.
Vertigo failed to improve or worsened with prior treatment of
low sodium diet or
diuretic in 53 (91%) of 58 cases.
Vertigo improvement was subsequently achieved in 48 (86%) of 56 cases with an autonomic treatment regimen. Long-term
vertigo control was obtained in 56 (88%) of 64 patients followed for at least 18 months.
Tinnitus was reported in 97 (86%) patients, aural fullness in 93 (82%) patients, and subjective
hearing loss (HL) in 46 (41%) of 111 cases. Bilateral
tinnitus and aural fullness occurred in 65% and 63%, respectively.
Tinnitus improved with treatment in 56 (67%) of 84 patients, whereas aural fullness improved in 59 (74%) of 80 patients. Autonomic symptoms included palpitations in 103 (91%) patients, chronic
fatigue in 102 (90%) patients, cold extremities in 91 (81%) patients, and previous
fainting in 72 (64%) patients. A history of
mitral valve prolapse was documented in 51 (45%) of cases and demonstrated with echocardiogram in 68 (93%) of the 73 patients tested. Audiologic testing was normal in 104 (95%) of 109 patients, and electrocochleography was abnormal in 42 (40%) of 105 patients. Orthostatic blood pressure and heart rate testing met the criteria for
orthostatic hypotension in 16 (15%) of 104 patients. Autonomic testing was obtained in 34 cases, with
orthostatic intolerance demonstrated in 33 (97%) patients and
orthostatic hypotension demonstrated in 13 (38%) patients. Overall,
orthostatic hypotension was documented through combined testing results in 23 (21%) of 107 patients.
Vertigo was reproduced during autonomic testing in 17 (77%) of 22 patients, and otologic symptoms were reproduce in 9 (47%) of 19 patients. Comparison of the study population with a control group without autonomic symptoms revealed statistically significant differences in orthostatic testing and treatment results. There was no statistical difference noted in findings between patients of this study that demonstrated or failed to demonstrate
orthostatic hypotension.
CONCLUSIONS: There is a subgroup of patients with spontaneous
vertigo who also demonstrate symptoms and findings consistent with poor autonomic regulation. These patients report
vertigo improvement with a treatment strategy that aims to improve autonomic dysfunction through expansion of effective circulating volume. Clinical findings and treatment results of this study suggest an underlying autonomic influence in the production of
vertigo and otologic symptoms.