Case 19

Age:                52

Gender:          F

The patient is an audiologist colleague who was then a distance AuD student and having dizziness problems. She sent her results, wanting a second opinion.

She has a long standing history of hearing loss in the right ear, which had been a mixed loss, mild to moderate, relatively flat configuration.  Previously, the left ear had normal hearing.

She had Ramsey Hunt, which occurred while on vacation, and she reports she thought she was having a stroke.  It affected her left side.  She developed hearing loss in the left ear with the disease.  She has had dizziness on and off since that time, which is described as an unsteadiness, not true vertigo.  She at times awakes with the dizziness even now, approaching one year after the bout of Ramsey Hunt.  She tends to “trip over her own feet” in the dark. She says she can’t move her eyes or head too fast – it provokes the dizziness.  Dizziness is currently provoked by looking up or bending down. She has considered the possibility of BPPV – symptoms seemed to have been aggravated by repetitive bending over.

She reports that pressure changes provoke dizziness.  After flying, her ears hurt for days. Her right ear has a constant ache.

There is some indication of hyperacusis. She reports that the noise of an ABR made her sick.  She says “I seem to have a low tolerance for loud noise.”

She has some crackling tinnitus which is intermittent and worse in the right ear. She comments “I have noticed a whooshing noise (left ear) on bending over. I’ve also felt or heard something like liquid. I have run a tymp to check .  A couple of days ago the tymp was uncomfortable on the left ear.”

She has had vestibular rehabilitation, when asked if it has helped she replied “Yes, I feel that it has helped recalibrate the VOR gain. I still do not do well driving the car. Exertion seems to make things worse. I have noted in the last two weeks rolling over onto the right side provokes nystagmus. This is noticed while in bed rolling over to turn the alarm off. “  In an earlier email she said: “I did have the vertigo this morning when rolling over to turn off the alarm. I am more aware of what is going on with my eyes. I can feel them bouncing, and I have to fixate to stop this. As I mentioned before my vertigo is more of an unsteadiness, like I am on a boat. I sway and veer when walking. What really bothers me is when I drive at night. I have stopped travel at night due to the instability.“

Otoscopy

There is no report of abnormality in the records.

  • List potential causes of her dizziness given her report.