Insulin resistance appears to be the basic abnormality in reversible metabolic vertigo syndrome, which, in our series, occurred predominantly in overweight patients.

In 1977, Updegraff identified hyperinsulinemia with idiopathic Meniere's disease. This finding was the first major impact of hyperinsulinemia in the clinical arena. Hyperinsulinemia is associated with idiopathic tinnitus, vertigo, and hearing loss.