Timothy C. Hain, MD Page last modified: October 6, 2013
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A middle aged woman presented to the clinic with a 1 month history of dizziness, imbalance, and a hearing disturbance. After some physical exertion, the room started spinning. This was preceded by a flu-like illness for about a week prior. She was given Augmentin (for uncertain reasons) and later on, prednisone and diazepam. When seen in the clinic, she had jumping vision, lightheadedness, positional vertigo, and left-sided hearing symptoms including a hissing locust-like sound (tinnitus), sensitivity to noise on both sides (hyperacusis), fullness on the left, and decreased hearing.
The patient was unable to stand in eyes-closed tandem Romberg (indicating imbalance). Under video Frenzel’s goggles, there is right-beating nystagmus in the dark. There was also strong right-beating nystagmus on vibration. There was no BPPV.
|Audiometry showed a high frequency sensorineural reduction on the left side.|
Audiometry is asymmetrical in persons with labyrinthitis.
|The VEMP test was reduced on the left.|
VEMP's are variable in labyrintitis. In severe cases, VEMP's are reduced. One would think that the lack of a VEMP would predict lack of posterior canal BPPV, as seen in this case.
|There was a weak right-beating nystagmus in the light, not much stronger in the dark. This pattern should make one suspect a technical error, as spontaneous nystagmus should increase in the dark.|
|Vibration greatly increased the amplitude of the spontaneous nystagmus|
Vibration usually increases spontaneous nystagmus in the dark.
|Caloric testing was reduced on the left in this case of labyrinthitis.|
This is a classic presentation of labyrinthitis. As time goes on, the spontaneous nystagmus will resolve but the other findings will remain.
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Understanding your dizziness and balance disorder DVD (has segment on Labyrintitis/vestibular neuritis).