Patient Presentation

A 45-year-old female presented with a two-year history of recurrent episodes of severe rotatory vertigo lasting 20 minutes to two hours. She reported fluctuating sensorineural hearing loss in her right ear, accompanied by low-pitched tinnitus and a sensation of aural fullness. Episodes occurred 2–3 times per month and were often preceded by a feeling of pressure in the ear.

Diagnostic Evaluation

Pure-tone audiometry showed a low-frequency sensorineural hearing loss in the right ear with a threshold of 40 dB at 250 Hz and 500 Hz, which partially improved during symptom-free intervals. Electrocochleography revealed an elevated summating potential/action potential (SP/AP) ratio >0.5, consistent with endolymphatic hydrops. MRI ruled out acoustic neuroma or other retrocochlear pathology. Clinical criteria from the American Academy of Otolaryngology—Head and Neck Surgery were met for definite Meniere's disease.

Management and Outcome

The patient was started on a low-sodium diet (less than 2 grams per day) and a diuretic (hydrochlorothiazide). Acute attacks were managed with oral meclizine and diazepam. Intratympanic dexamethasone injections were administered twice, which reduced vertigo frequency by 70%. At 12-month follow-up, the patient reported only occasional mild episodes without significant progression of hearing loss. Tinnitus remained stable but less intrusive.

Discussion

This case illustrates the classic triad of episodic vertigo, fluctuating hearing loss, and tinnitus with aural fullness typical of Meniere's disease. Early recognition and lifestyle modifications can help preserve hearing and reduce vertigo burden. The role of endolymphatic hydrops as the underlying pathophysiology is supported by audiometric and electrocochleographic findings.