I think this is absolutely the case, and you should publish this in a leading subscription ENT journal.   Meniere's disease as recognized in ENT departments is not very common, but Meniere's Spectrum Disorder is extremely common, and not just in ENT departments.   MSD is due to hydrops, but in a different combination of symptoms, though in no way less distressing.  The main feature of hydrops is a hyperactive state of the inner ear (tinnitus, audiosensitivity, vertigo, etc).   When I reviewed the literature on musical hallucination, another important feature revealed itself, that is a much increased sensitivity to a very wide range of drugs, which aggravated the symptoms.  The inner ear is the body's sentinel for toxins, containing an exquisite system for detecting metabolic anomaly, then quickly expelling the poison (vomiting).

I believe that most vertigo attributed to central factors is in fact undiagnosed hydrops.

PTA at 125Hz is helpful.  Even if low tones are quite normal, repeat PTAs usually show excessive fluctuation within normal limits.

I have never seen any evidence for malingering in vertigo.   Has this ever been a problem in the army?

Hi, thank you for the information. 

yes, exactly. I have a lot of patients from army. In discussion with ENT physicians we got concern about prevalence of vertigo especially in air force. we want to be sure in diagnosis.

Inner ear symptoms and disease: Pathophysiological understanding and therapeutic options

Raphael R. CiumanA,B,C,D,E,F

Abstract

In recent years, huge advances have taken place in understanding of inner ear pathophysiology causing sensorineural hearing loss, tinnitus, and vertigo. Advances in understanding comprise biochemical and physiological research of stimulus perception and conduction, inner ear homeostasis, and hereditary diseases with underlying genetics. This review describes and tabulates the various causes of inner ear disease and defines inner ear and non-inner ear causes of hearing loss, tinnitus, and vertigo. The aim of this review was to comprehensively breakdown this field of otorhinolaryngology for specialists and non-specialists and to discuss current therapeutic options in distinct diseases and promising research for future therapies, especially pharmaceutic, genetic, or stem cell therapy.

Keywords: inner ear disease, sensorineural hearing loss, tinnitus, vertigo, genetic therapy, stem cell therapy, Meniere’s disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872449/

Hi, Thank you. So comprehensive.

if one do not hv e-cog facility , how can one diagnose endolymphatic hydrops?

Hi, I think Meniere's disease can mostly be suspected based on case history: Attack like true vertigo (it can happen in sleep or during rest) that is not provoked by head movements, duration of 20 minutes or more (many times patients call emergency), tinnitus and ear fullness before or during attack, most of the times the day after attack patient is seen for auditory evaluation and usually a low tone loss is seen. These are indicative of endolymphatic hydropse. I had a patient recently and she said she was walking in the street and suddenly she heard ocean waves for some minutes. Then suddenly she fell to her left side really fast and dangerously (fall attack). She showed increased SP/AP in right ear. When she came to our facility she had ear fullness too but there was not any low tone loss. It was her first attack. case history is really important. I have noticed history of allergy in many cases. some patients have vertigo in family but they do not tell that in case history and we should ask it. 

"how can one diagnose endolymphatic hydrops?2

I am reviewing the literature to check if any condition causing low perilymph pressure also causes  hydrops.   This includes a lot of very old studies before any tests were available, but it is usually quite easy to make this diagnosis retrospectively from the reported details.   In other words, it can be a completely clinical diagnosis.  The most characteristic symptoms, even in isolation, are

• Aural fullness, blocked ear
• Audiosensitivity, intolerance of noise
• Concentration problems, brain fog
• Unexplained dizziness
• Fluctuating tinnitus
• Dull distorted hearing

 I had a 12 year old patient that she suddenly suffered from severe vertigo. She was referred to ENT settings. Mostly they prescribed antibiotics and vertigo suppressants. She had to leave school. she could not walk without help or stand straight. she did not have any hearing loss. I performed VNG testing, there was down beating spontaneous nystagmus and down beating positional nystagmus (really severe). Other VNG test battery was normal. I sent her for MRI and it was normal. Other brain tests and blood exams were normal. Migraine was ruled out. Neurologists and Otologists were confused and did not know what to do. Specially her symptoms were permanent and she felt worse during changing position from sitting to lie down. We performed EcochG and shockingly SP/AP was really high in both ears. Patient took Meniere medications and in less than one week she recovered totally. She has been without any problem for two years now. 

" we got concern about prevalence of vertigo especially in air force. we want to be sure in diagnosis."

I would actually be more concerned with the early stages of hydrops, ie Meniere Spectrum Disorder.  One of the NASA astronauts in charge of a moon landing had been operated on for Meniere's disease, and was passed fit.

yes, there is a concern

what medicction is most effective for meniere spectrum disorder now a days?

"what medicction is most effective for meniere spectrum disorder now a days?"

One of the interesting observations by reliable observers that I picked up from reading the old literature is that the same drug or toxin that triggered Meniere's disease in some patients was used as a treatment for it by other doctors, eg quinine.  So there is unlikely to be a simple answer to this question of treatment. 

Sir, how has been quinine used in MSD.duration , dose, dosagea and safity of this antimalarial?

In normals, "The action of quinine first makes itself evident by the presence of subjective noises, and by a diminution in the hearing which usually takes place within one to three hours".

"Prognosis of the apoplectic form of Meniere's disease is unfavourable...The effect of quinine (0.5-1.0 gramme pro die), as recommended by Charcot, must, however, be carefully watched in each case, as sometimes even moderate doses may produce the opposite effect--that is, great excitement and increased tinnitus". 

A Politzer  Diseases of the Ear 5th Ed 1910.

Politzer (see previous post) states (p 730):

"It is also well known that the auditory nerve is more affected than any of the other nerves of special sense by the action of drugs circulating in the blood".

 By auditory nerve, he means auditory nerve apparatus including the inner ear.  As these drug effects are usually temporary, the obvious candidate is hydrops, indeed it is hard to come up with any plausible alternative physiological mechanism.