Definite Vestibular Paroxysmia Comorbid With Definite Ménière's Disease: A Rare Case Highlighting Diagnostic and Therapeutic Implications.

Ménière's disease (MD) is characterized by episodic vertigo lasting 20 minutes to several hours with fluctuating sensorineural hearing loss. Vestibular paroxysmia (VP) involves brief, recurrent vertigo attacks that typically last less than one minute and are often responsive to carbamazepine. While both diseases can present with accompanying auditory symptoms during vertigo attacks, they differ in attack duration and drug responsiveness. Here, we report a case of definite MD that was subsequently complicated by definite VP. A 46-year-old man presented with fluctuating right-sided sensorineural hearing loss and recurrent vertigo episodes lasting about one hour, consistent with definite MD. Gadolinium-enhanced MRI demonstrated significant endolymphatic hydrops in the right vestibule without neurovascular compression. Initial treatment with isosorbide improved vertigo. One year later, he developed multiple brief vertigo spells per day, each lasting about one minute and accompanied by tinnitus and nystagmus. These episodes were unresponsive to isosorbide but resolved rapidly after carbamazepine administration, leading to a diagnosis of comorbid VP. This case illustrates the diagnostic challenge of sequential MD and VP while emphasizing the educational value of recognizing their differences in attack duration and pharmacological response in clinical practice.