A 37-year-old man came to the office with a 3-year history of nausea and vomiting, which were precipitated by rotary vertigo. Once the dizziness stopped, the man said he felt "perfectly fine." The pattern of his spells was irregular, occurring once a week, once a month, or once a year. They typically lasted 1 to 2 hours, occasionally up to 3 hours. An injectable antiemetic would lessen the duration of a spell. He also had a 5-year history of hearing loss in the right ear. Initially, the loss was sudden, but his hearing returned with diuretic therapy. His hearing remained normal until the onset of the dizziness 3 years earlier. His hearing decreased a few months before the first spell and returned about 2 weeks later. In recent months, however, his hearing would drop 2 days before a spell and return with the use of a diuretic. Two years before his visit, tinnitus in the right ear began to accompany the hearing loss. Hearing loss also began to be accompanied by aural fullness in the right ear, which resolved w hen the hearing returned. He was taking betahistine, triamterene/hydrochlorothiazide, chlordiazepoxide, and lipoflavinoid.
Electronystagmography revealed no spontaneous, positional, or neck torsion nystagmus. The alternate binaural bithermal revealed slightly hyperactive caloric responses in the left ear. There was a 12% reduced vestibular response right and a 7% right directional preponderance, both well within the range of normal. The simultaneous binaural bithermal revealed a type 3 right-beating nystagmus response to both caloric stimuli. This finding was abnormal in keeping with his vestibular symptoms and, like the finding of directional preponderance, has no localizing value.
From Neurotologic Associates, P.C., New York City.
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