Acute labyrinthine disorders.

A patient seeking emergency treatment for a labyrinthine disorder is usually complaining of dizziness. The task at hand in the emergency room is, first, to rule out the truly life threatening emergent disorders, and then by means of a rapid but adequate history and physical examination to aid in the differentiation between central and peripheral etiologies. If the problem is central, and especially if there are signs of a true emergency, there should be no hesitation in sharing the responsibility for the care of this patient with a neurologist or neurosurgeon. If one is convinced that the problem is of a peripheral etiology, one most likely is dealing with Meniere's disease, vestibular neuronitis, benign paroxysmal positional vertigo, or true labyrinthitis. An acoustic tumor must always be considered. Appropriate laboratory and x-ray studies may be initiated and therapy begun. Although the emergency room evaluation can be inclusive and accurate, it is necessarily incomplete. There is no substitute for a more thorough history and physical examination under more relaxed conditions, complete audiometry, electronystagmography, polytomography, myelography, angiography, or whatever additional sophisticated studies are deemed necessary. If performed well, however, the emergency room encounter forms an invaluable foundation upon which further diagnostic and treatment decisions are based.