The answer is A. Meniere disease
Episodic vertigo lasting minutes to hours with fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness is Meniere disease, and those four features together are the diagnosis. The underlying problem is endolymphatic hydrops — an excess of endolymph distending the membranous labyrinth, thought to arise from impaired resorption. When the distended membrane ruptures, potassium-rich endolymph spills into the perilymph and transiently poisons the hair cells and vestibular nerve, which is why an attack is abrupt, severe, and then resolves as the membrane heals and the fluid compartments re-separate. That mechanism explains the tempo, and the tempo is how you tell these disorders apart. Duration is the single most useful discriminator in vertigo, and it is worth memorizing as a ladder: seconds to under a minute, positional, is BPPV; minutes to hours with hearing symptoms is Meniere; days, constant, without hearing loss is vestibular neuritis; days, constant, with hearing loss is labyrinthitis; and months of slowly progressive unilateral hearing loss is a vestibular schwannoma. The hearing loss here is also distinctive: it is low-frequency early on, and it fluctuates, which almost nothing else does. Over years it becomes permanent and flattens across frequencies. Diagnosis is clinical, supported by audiometry; obtain an MRI of the internal auditory canals when the presentation is unilateral and progressive, specifically to exclude a schwannoma. Management is a layered plan. Start with sodium restriction, typically under 2 grams daily, plus avoidance of caffeine, alcohol, and nicotine, and add a thiazide or thiazide-like diuretic to reduce endolymphatic volume. Treat acute attacks symptomatically with vestibular suppressants such as meclizine or a benzodiazepine, and antiemetics — but use them only for attacks, because chronic suppression prevents central vestibular compensation. Refractory disease escalates to intratympanic corticosteroid injection, then intratympanic gentamicin for chemical ablation, and finally surgery (endolymphatic sac decompression, labyrinthectomy, or vestibular neurectomy). Counsel on fall and driving safety, since attacks arrive without warning. Sorting the distractors: benign paroxysmal positional vertigo produces brief spells of seconds triggered by head position, diagnosed with the Dix-Hallpike maneuver and treated with the Epley maneuver, and it causes no hearing loss or tinnitus; vestibular neuritis gives a single prolonged attack of continuous vertigo lasting days with normal hearing; labyrinthitis is vestibular neuritis plus hearing loss, but it is likewise a single sustained illness rather than recurrent discrete attacks; and a vestibular schwannoma causes gradual unilateral sensorineural hearing loss with tinnitus and unsteadiness rather than dramatic episodic vertigo, and may add facial numbness from trigeminal involvement — it is the diagnosis MRI is ordered to exclude.
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