Pathologically, the disease is caused by swelling of the endolymphatic compartment, with eventual rupture of Reissner's membrane and mixture of endolymph and perilymph. The classic triad of symptoms consists of episodic vertigo, fluctuating hearing loss, and tinnitus. However, a fourth and fairly consistent symptom is pressure or fullness in the affected ear. The classic attack lasts 20 minutes to several hours and may occur as often as daily. The sensorineural hearing loss early in the disease is reversible but in time becomes a permanent disability.
Appropriate treatment is highly controversial.
Medical management has included control of allergies, low sodium diet with hydrochlorothiazides, Antivert, Valium, and vasodilators, while surgery may be required in unresponsive cases. Bell's Palsy is a diagnosis of exclusion and is necessarily idiopathic. Temporal bone trauma, stroke, cholesteatoma, parotid tumors and other disease may cause facial paralysis, but it is inappropriate to call these conditions Bell's Palsy. Site of lesion testing will begin with examination for sparing of the forehead. Central lesions which affect fibers prior to their synapse in the 7th nerve nucleus in the brainstem spare forehead musculature.