crisis tumarkin drop attack menieres

Otolith Crisis of Tumarkin

In the past decade, we have had our share of events that have been labeled a crisis. We had the housing crisis, then the stock market crisis. Today, we are going to talk about a different kind of crisis. Originally described in 1932, the otolith crisis of Tumarkin (also described as a “Drop Attack“) is a rare but frightening presentation of Meniere’s disease.

The medical dictionary defines the otolith crisis of Tumarkin as a “sudden unexplained fall without loss of consciousness or vertigo, attributed to abrupt change in otolithic input, resulting in an erroneous vertical gravity reference which, in turn, generates an inappropriate postural adjustment via the vestibulospinal pathway, resulting in a sudden fall.”

 Just like many other aspects of Meniere’s disease, the exact physiology behind these attacks is speculative.

 

Meniere’s Disease: Drop Attacks

 

An article on Medscape describes the otolithic crisis of Tumarkin.  “According to the theory, excessive fluid accumulation deforms the otolith apparatus of the inner ear (the utricle and saccule), with a resultant overpowering feeling of tilting or falling. Patients attempt to reconcile this feeling with external reality and fall to the ground uncontrollably and suddenly. They may strike their head on a hard surface, causing severe injury, as there is no warning of the attack in most cases. The possible lack of warning that the feeling is imminent could cause a patient who is driving in heavy traffic to be unable to control the vehicle or apply the brakes.”

An educational brochure from Meniere’s.org.uk offers a slightly different hypothesis.

 

“A drop attack feels as if you are being pushed violently and suddenly, causing you to fall. Symptoms are usually gone as quickly as they appear, and you can get up straight away and carry on with whatever you were doing (unless you get a drop attack at the same time as an acute attack of vertigo). During these attacks, the hair cells on your otoliths are suddenly activated, causing your balance to be severely disrupted. Experts do not know how or why this happens.”  

 

An article in the Sunday Express Newspaper (London) describes the otolith crisis of Tumarkin from the patients perspective.

“The most frightening symptoms were Tumarkin’s otolithic crises, also called “drop attacks”, which cause a sufferer to fall to the ground with no warning only to recover quickly.”

“Drop attacks are like being pushed forcefully across a room.”

“You feel the force and you go flying but then you can just get up again,” Emma says. “I was once in the ladies toilets and the next thing I knew I had my head in a flowerpot at the other side of the room.”

“The boys would laugh when I went flying across a room when they were younger but it was actually very distressing not to have any control over it.”

The only treatment option discussed is to perform an ablative procedure such a gentamicin injection or nerve section on the suspected ear.

 

 

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About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.

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