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The cervicogenic otoocular syndrome: a suspected forerunner of Ménière's disease.

Over a period of 4 years, 420 patients were observed with fullness in the ear, episodic vertigo, fluctuating hearing, and tinnitus. Of them, 182 patients showed normal hearing levels, a mild eustachian tube dysfunction, normal SP/AP ratios, mydriasis on the side of the affected ear, and a functional disorder of the upper cervical spine. These patients responded to conservative management, particularly physiotherapy. Additionally, 51 patients showed normal hearing levels, a mild eustachian tube dysfunction, an elevated SP/AP ratio suggesting endolymphatic hydrops, mydriasis on the side of the affected ear, and a functional disorder of the upper cervical spine. These patients were given a diagnosis of cervicogenic otoocular (COO) syndrome. Within this group, 43 patients did not respond to preceding conservative management, and 3 patients developed Ménière's disease within 12 months. Also within this group, 8 patients responded to physiotherapy only, with return of the SP/AP ratio to normal levels. A total of 187 patients had a sensorineural hearing loss, an elevated SP/AP ratio, mydriasis on the side of the affected ear, a functional disorder of the upper cervical spine; 186 had a mild eustachian tube dysfunction and had diagnosed Ménière's disease. Patients with a COO syndrome invariably responded to the insertion of a middle-ear ventilation tube, with return of the SP/AP ratio to normal levels and relief of symptoms. Patients with Ménière's disease had a mixed response. The COO syndrome is suspected to be a forerunner of Ménière's disease.