J.F. is a 90 year old male, with dementia. The presenting problems and history are reported by his wife.  About 3 weeks prior to the evaluation he first experienced dizziness. The spells are indicated as lasting 5 minutes in the case history questionnaire at one point, then 2 minutes at a later point, but 1 minute in the oral interview notes.  Attacks occur about twice per week.  He tried Meclazine, but it was not helpful.

Associated symptoms are listed as follows.

-Feeling of spinning while the world around is stationary, present with eyes open or closed

-Blurring of the visual field

-Sensations of swimming, spinning, lighthededness, with headache.

The case file had several questionnaires in it.  The wife at one point says  the patient has veering and falling to the left.   At another point she checks off veering to the right.  The patient ambulates with a walker.  ”Imbalance” is reported.

-Provoked by rolling to the right or lying down.  He also gets “dizzy” when his colostomy bag is changed.  (It wasn’t noted if he has to lie down to have the bag changed.)

-Nausea is not reported.

-Symptoms appear to be related to fluid retention. The patient takes diuretics.

-Tinnitus is not reported, nor is aural pain or fullness.

Other information of note: the patient has macular degeneration, high blood pressure, is on blood thinners, and predisone (indication for its use not given.)  He has remained on all medication except for the diuretic as he comes in for testing.

Hearing loss is supsected, there is history of otitis media in the right ear and service-related noise exposure.

The “bedside” vestibular tests (Fakuda, sensory organization) could not be administered because the patient needs a walker to ambulate.

Case credits: Julia Andrews, AuD, South Florida ENT