Vertigo of Delayed Onset after Sudde Deafness and Sensorineural Deafness Followed by Mumps

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An entity of episodic vertigo of delayed onset following sudden deafness and sensorineural hearing loss after mumps is described. Data on five patients with sudden dafnfess and three patients with sensorineural hearing loss after mumps are presented. The latency between sudden onset of sensorineural hearing loss and the onset of the vertigo varied from four days to six years.There is no patient with sudden deafness who had a history of vestibular symptoms at the time of the sudden loss of hearing. Two out of three patients who had sensorineural hearing loss after mumps had a simultaneous involvement of the vestibular apparatus, with transient vertigo. The episodic vertigo, delayed in onset after sudden sensorineural hearing loss in the eight patients was usually spontaneous. Postural vertigo was noted in only one patient.The nature of the inner ear pathology responsible for the episodic vertigo in these patients is speculative. One patient after sudden deafness had an episodic vertigo accompanied by tinnitus in the previously deafened ear. The characteristics of vertigo in this patient are indistinguishable from those seen in cases of Meniere's disease. The pathophysiology of the vertigo in this patient was found to be related to endolymphatic hydrops.The delay of four days to six years between the sudden onset of hearing loss and the later onset of ipsilateral otogenic vertigo is puzzling. Schuknecht and others have suggested that viral labyrinthitis is the likely etiology of sudden deafness. Cochleosaccular degeneration is a common finding in documented viral labyrinthitis. Zajtchuk stated that the pathophysiology of viral labyrinthitis involves an acute stage and a chronic stage. In the chronic stage, degeneration process of neural elements, new bone formation and fibrous tissue take place in the membranous labyrinth. Thus, episodic vertigo may be the result of a progressive inner ear degeneration after sudden sensorineural hearing loss.