Differential diagnosis of exacerbated Menière’s disease

A now 74 year old patient has been treated since seven years for Meniere’s disease on the right ear. The initial brain-MRI scan was unremarkable. The treatment with Betahistine and a myringotomy tube resulted in a relief from symptoms for many years. As vertigo occurred in October 2016, a labyrinth anesthesia by administration of lidocaine through the T-tube was repeatedly performed which resulted in a relief from symptoms. In summer 2018, the vertigo became worse so another brain-MRI scan was performed, which showed no abnormalities. In April 2019 the patient reported having increasing vertigo, a drop attack and also right-sided hearing loss. In addition to an endolymphatic hydrops II° (Barath et al.), there were also supra- and infratentorial lesions suspicious for metastases. A CT scan of the whole body followed, which showed a pulmonary nodule in the upper lobe of the left lung, suspicious for lung cancer as a primary malignancy. The skeletal system showed osteolytic metastases. The histologic findings obtained through CT-assisted puncture showed a non-small cell lung cancer/ adenocarcinoma stage IV (cT1bpN0M1c).

The patient did not have any symptoms, except for the neurotological findings reported above. He was a non-smoker and regularly underwent the screening for prostate-, colon- and skin cancer.

A therapy was started with radiation of the brain, chemo- and immunotherapy, which showed remission of the bronchial tumor, but progression of the brain metastasis.

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Publication History

Article published online:
10 June 2020