Vestibular involvement in myringitis bullosa

Objective - Cochlear involvement manifested by sensorineural or mixed-type hearing loss (HL) has been reported to occur in 30-67% of patients suffering from myringitis bullosa (MB). The goal of this study was to investigate the incidence and nature of vestibular involvement in MB. Material and Methods - All adult patients presenting to Hadassah University Hospital with MB between 2000 and 2002 were evaluated for inner ear involvement. Audiometry, tyrapanometry and electronystagmography (ENG) were performed within the first 48 h after presentation. The affected ears were examined on a regular basis and audiometric studies were repeated every other day. ENG was not repeated but a detailed questionnaire was administered and a thorough physical examination performed to rule out persistent vestibular dysfunction. Results - Thirteen patients (17 ears) were diagnosed as suffering from MB. All 13 patients reported HL in the affected ears and 7 (54%) reported a sensation of vertigo at presentation. Audiometric tests revealed HL in all 17 affected ears: sensorineural HL in 2, mixed-type HL in 12 and conductive HL in 3. ENG was normal in only two cases, both of whom did not suffer from vertigo. Four patients with no vestibular symptoms whatsoever had an abnormal electronystagmogram. All seven patients who complained of vertigo had an abnormal electronystagmogram and recovered fully after treatment. All but two patients recovered their auditory function. Conclusions - Not only is the cochlear part of the inner ear affected in patients suffering from MB, but the vestibular part as well. Sensorineural HL and vestibular abnormalities should both be considered as manifestations of MB.