Vestibular nerve section has been performed in cases where hearing preservation is desired. However, this form of surgery has become less popular since the widespread introduction of IT gentamicin. Labyrinthectomy is more desirable in patients who already have a substantial degree of hearing loss (Gacek & Gacek, 1996). Ablative procedures are generally effective in alleviating the disabling attack of vertigo, and patients typically recover quite well due to the principles of central compensation following a stable unilateral vestibular system weakness. Ultimately, whether an individual is “disabled” is a fact-intensive inquiry for the courts. To prove that one is “disabled” due to Ménière’s Disease under the ADA means to prove by a preponderance of the evidence that it affects one or more of an individual’s major life activities.
Episodic downward-shift diplacusis is a phenomenon where individuals experience a shift in pitch perception after exposure to loud noises. This condition can be disorienting and affect a person’s ability to understand speech or enjoy music. Some research suggests that this symptom may be indicative of Meniere’s disease, a chronic disorder of the inner ear.
Meniere’s disease is characterized by episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness or pressure in the ear. While each individual may experience different symptoms, episodic downward-shift diplacusis has been reported in some cases as an early sign of the condition. It is important for individuals experiencing these symptoms to seek medical attention for a proper diagnosis.
This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open access content, the Creative Commons licensing terms apply. Hearing loss is initially episodic but may progress to a persistent loss, classically a sensorineural loss in low frequencies. This manuscript is part of a supplement sponsored by the German Federal Ministry of Education and Research within the funding initiative for integrated research and treatment centers.
It is not uncommon for loud sounds to be very uncomfortable and to appear distorted in the affected ear. To determine the severity of the impact on the patients’ quality of life, several symptom-specific scoring instruments have been developed. Such rating scales are, e.g., the Hearing Disability and Handicap Scale [33, 34], the Vertigo Handicap Index [35], and the International Tinnitus Inventory [36]. A MD-specific indicator is the MD Patient Oriented Severity Index (MDPOSI) [37]. Some of these have been developed to evaluate changes in the natural course or therapeutic effects, such as MDPOSI. The symptom-specific instruments seem to more accurately reflect changes in control of vertigo in MD over time than do, e.g., general Quality of Life (QoL) instruments [32].
Diagnosing Meniere’s disease can be challenging as there is no specific test to confirm the condition. Medical professionals will typically conduct a thorough medical history, physical examination, and hearing tests to rule out other possible causes of the symptoms. In some cases, imaging studies such as an MRI may be ordered to further evaluate the inner ear structures.
It is crucial for individuals experiencing episodic downward-shift diplacusis along with other symptoms such as vertigo and hearing loss to consult with an otolaryngologist or ENT specialist. Early detection and management of Meniere’s disease can help improve quality of life and prevent further damage to the inner ear. Treatment options may include dietary changes, medication, vestibular rehabilitation therapy, and in severe cases, surgical intervention.
In conclusion, while episodic downward-shift diplacusis can be a distressing symptom, it is essential to consider the possibility of underlying conditions such as Meniere’s disease. Seeking timely medical evaluation and appropriate treatment can help individuals manage their symptoms and maintain a better quality of life.
In a study comprising of 111 patients with Meniere’s disease, pure tone and speech audiometry was performed. An objective classification method used to determine audiogram shape indicated that affected ears more frequently show “low” or “low + high” hearing losses. The study concluded that shape of hearing loss does not depend on duration of affection of disease [24]. Obtaining “disabled” status under the ADA is a threshold issue to achieving its statutory protections. The episodic nature of Ménière’s Disease can create a significant barrier for individuals to avail themselves of the ADA’s relief. In doing so, claimants can further educate courts about the disabling nature of Ménière’s Disease for many individuals and specifically how it has affected them.
MD is thought to be caused by endolymphatic hydrops, which has been visualized both in pathologic temporal bone specimens and in vivo via magnetic resonance imaging. Multiple theories exist regarding the etiology of endolymphatic hydrops and the mechanism by which endolymphatic hydrops causes the symptoms of MD. MD is principally diagnosed based on clinical assessment and audiometric documentation of hearing loss; however, a variety of adjunct vestibular tests can be used to differentiate MD from similar disorders.
