M.S. is a 40 year old female with recent onset of dizziness the first time she was seen at South Florida ENT Associates  (SF ENT).

Four months prior she exhibited hearing loss which appeared from the symptoms to be conductive. She was seen by an ENT, and the hearing loss resolved.

Five days prior to her first ENT appointment at SF ENT, she had sudden onset dizziness, left hearing loss, nausea and vomiting, and ear pressure.  The dizziness lasted six hours; she received emergency room treatment with Antivert and Valium, and remains on Valium at night and another anti-vertigo medication.

Her medical history is positive for rheumatoid arthritis and hypothyroidism.

Six years later she is seen for VNG testing. History in the intervening years and other test results are in the “Instructor’s Guide”.  Reviewing her symptoms and the following test results, you will then be asked your tentative diagnosis and what other testing would be needed to support your diagnosis.

At the VNG evaulation she reports the following.

-Visual blurring/jumping during head motion

-Objects spin around her with eyes open

-Loss of balance when walking. She can’t tell which way she veers/falls.

-Lightheadeness

-Headache / head pressure

-Nausea / vomiting during episodes

-Fluctuating hearing loss in the left ear with attacks, and sounds are distorted

-Tinnitus, described as a rushing sound, worse during attacks

-Neck injury, 2 herniated disks

-Attacks last several hours, and occur spontaneously and do not seem to be triggered by head movement

• Without looking ahead, what are you expecting as the pathology, and what testing do you need to make that confirmation?

Case donated by Julia Andrews, AuD, South Florida ENT Associates.