By Marcello Cherchi, MD PhD
For patients
In some patients who have had Ménière’s disease for a long time, they begin getting abrupt attacks of falling to the ground. Such an attack (when due to Ménière’s disease) is called an “otolithic catastrophe of Tumarkin,” and is not usually prevented by oral medications. They are dangerous because of how abrupt they are, so if a patient with Ménière’s disease begins getting these, they generally consult an ENT to be evaluated for a more definitive surgical procedure to treat Ménière’s.
For clinicians
In advanced stages of Ménière’s disease, approximately 9% of patients (Wu, Li et al. 2019) develop drop attacks, which came to be known as the “otolithic catastrophe of Tumarkin” after the first clinician to describe this, Alexis Tumarkin (Tumarkin 1936). Drop attacks have no prodrome, and thus patients have no warning that an attack will occur. Since such attacks are dangerous, this usually merits more aggressive treatment for Ménière’s disease, such as surgical management (gentamicin injection, vestibular neurectomy, etc.), as oral medications are generally ineffective.
Given that an otolithic catastrophe of Tumarkin occurs abruptly (and such occurrences tend to have a very erratic chronology), it is extremely unusual for a clinician to witness. Nevertheless, some cases have been recorded.
Chen and colleagues (Chen, Zhang et al. 2020) reported a case caught on surveillance camera, shown below and here.
One of our patients also had an attack captured on surveillance camera, shown below and here.
The former CEO of BMW, Harald Krüger, who reportedly suffers from Ménière’s disease, had an attack during a press conference at the Frankfurt International Motor Show in Septmber of 2015, shown below and here. This attack appeared somewhat less violent than the two shown above.
References
Chen Z, Zhang Y, Zhang Q (2020) Tumarkin Drop Attack Recorded by Video Surveillance. JAMA Neurol. doi: 10.1001/jamaneurol.2020.0884
Tumarkin A (1936) The Otolithic Catastrophe: A New Syndrome. Br Med J 2: 175-7.
Wu Q, Li X, Sha Y, Dai C (2019) Clinical features and management of Meniere’s disease patients with drop attacks. Eur Arch Otorhinolaryngol 276: 665-672. doi: 10.1007/s00405-018-5260-5
