A 42-year-old female presents with recurrent episodes of intense vertigo lasting 2 to 4 hours, accompanied by fluctuating low-frequency sensorineural hearing loss, roaring tinnitus, and a sensation of fullness in her left ear. What is the most likely diagnosis?

Answer and explanation

Correct answer: D. Ménière's disease (endolymphatic hydrops)

  1. Step 1: Identify clinical tetrad: Episodic vertigo lasting hours, fluctuating low-frequency hearing loss, tinnitus, and aural fullness.
  2. Step 2: This constellation represents endolymphatic hydrops, clinically diagnosed as Ménière's disease.
Answer
Ménière's disease (endolymphatic hydrops).
Why not the others: 'BPPV' causes brief vertigo lasting seconds triggered by head position changes (positive Dix-Hallpike); 'Vestibular neuritis' causes continuous vertigo lasting days without auditory symptoms; 'Acoustic neuroma' causes progressive, non-fluctuating high-frequency sensorineural hearing loss over months.

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