During vertigo spells in Meniere's Disease, low frequencies are more affected than the high ones.
But in my experience, it is not so uncommon the high frequency affectation during vertigo attacks.
Do you have some experience?
For a long time the low tones in Meniere's disease and Meniere Spectrum Disorder fluctuate and can renormalize. The high tones start to progressively deteriorate from the start of the disease, and show less tendency to fluctuate. Hence there are different causes for the low and high tone losses.
I agree you, at least in the majority of the cases, but I have some experience in fluctuating in the high tones, without any alteracion of the low or medium tones.
Some authors agree that the low tone fluctuations, are common, but not the rule, existing in 30-40% of the cases:
I was wondering, how many could have a high tone hearing loss fluctuation?
"I have some experience in fluctuating in the high tones, without any alteracion of the low or medium tones."
I have never seen this, nor read about it, so if you have such cases, they are definitely worth publishing. However, it would be very surprising if this had not been picked up in the past, so a very thorough literature research from early last century would surely turn up any such cases.
I have some doubts about such fluctutations. As you say, they are rare and not necessarily attributed to the syndrome, but some authors like Stahle and Friberg drawed attention to any other frequencied affected than the lower ones.
If the hypothetical endolymphatic hydrops mechanism, which is accumulation of high pressure or high volume of endolymph is correct, especially in the early period of the pathology, mainly the apical portion of the basilar membran ought to be affected considering that the problem is only related to the high pressure or high volume of endolymph! These two probably go together in the beginning of the process. As you know, apical portion is less stiff (almost in the factor 100 times) compared to basal portion of basilar membrane. High pressure can affect less stiff part (i.e. outer hair cells of the apical part mainly) more than the stiff basal part. However, as the process develops by the time, outer and progressively inner hair cells not only affected functionally, but also lose their integrity. This can be followed from the pure tone audiometry as a flat configuration. Thus, if there is high freq alteration in the beginning of the pathology, it is a surprising finding, or it does not fit what we think regarding the hypothetical mechanism of Meniere's Disease.
Majority of Meniere's cases, seen in my clinic, had fluctuated low tones deafness particularly in early stage of disease. Also majority of such cases did not restore normal hearing despite proper management which improves vertigo. In late stage of disease, vertigo improved by treatment but deafness sometimes deteriorates including all tones & hearing aids were prescribed.
Yes Fluctuated high frequency hearing loss and those atypical cases usually secondary hydrops
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