The most important differential diagnoses are molding that occurs during birth in young infants, and positional molding that occurs as a result of excessive time spent in the supine position in older infants. The diagnosis may be confirmed by plain films of the skull, and surgical treatment is usually indicated to prevent neurologic complications. Pennsylvania Meniere's disease may be the underlying cause of dizziness, which is a common presenting complaint. Because these symptoms may or may not develop or occur simultaneously, a careful history and a complete physical examination are necessary for diagnosis. If Meniere's disease is present but untreated for 10 or more years, hearing may deteriorate as the vertiginous episodes gradually subside.
Medical management includes sodium restriction and the avoidance of caffeine, alcohol and nicotine.
Diuretics, antiemetics, antidepressants and vestibular suppressants may be prescribed, and surgery may be considered in severe, unresponsive cases. It occurs in endemic areas throughout the tropical parts of the world, with a predilection for developing countries where poor socioeconomic conditions are favorable for mosquito vector breeding. Between 1983 and 1993, more than 3 million immigrants to the United States reported their native residence to be a country with areas of endemic filariasis. These immigrants comprise approximately 1 percent of the U.S. population. Thus, it is likely that patients with lymphatic filariasis present within the American health care system and may be overlooked.