Nystagmus During a Vertigo Crisis in Menière’s Disease—Direction of Nystagmus, Contribution of a Mobile Phone and Therapeutic Implications

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Abstract
Background/Objectives: Spontaneous nystagmus during vertigo attacks of Menière’s disease has been essentially described as horizontal, beating ipsilaterally (irritative type) or contralaterally (deficit type) to the hearing loss. Our main objective was to describe the characteristics of nystagmus during vertigo attacks. The second objective was to determine the feasibility of self-video recording of eye movements by a mobile phone. The third objective was to discuss the therapeutic implications of the observed nystagmus. Methods: We selected patients with definite Menière’s disease according to the Barany Society. Patients were video-recorded during their attacks by videonystagmoscopy (by the physician) and/or mobile phone (by the patient or immediate surroundings). Results: Seventeen patients were video-recorded by mobile phone (n = 8) or videonystagmoscopy (n = 8) or both (n = 1). The nystagmus was horizontal in 14 patients of the irritative type (n = 7) and of the deficit type (n = 5) or changed from the deficit to the irritative type (n = 2). The nystagmus was vertical in three patients, either down-beating (n = 2) or up-beating (n = 1). This vertical nystagmus changed to a more classical horizontal nystagmus in two patients. Conclusions: The direction of the nystagmus was variable and mostly horizontal, although it could be vertical and could change direction. Thus, the direction of the nystagmus has no value in deducing the affected side of Menière’s disease, which essentially relies on hearing dysfunction. The nystagmus could be video-recorded by a mobile phone, which was objective proof of the impact on daily life. This was a helpful therapeutic aid, particularly when chemical labyrinthectomy was considered.

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