Woman’s sudden dizziness and hearing loss had a rare cause

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Air bubbles trapped in a woman’s inner ear left her severely dizzy, seemingly out of nowhere, and she had to undergo surgery to make the feeling of disorientation and spinning go away.

The 51-year-old first went to the doctor after experiencing this strange spinning sensation for around 24 hours, according to a report of the case published Thursday (April 21) in the newspaper JAMA Otorhinolaryngology–Head and Neck Surgery. Along with feeling like the room was spinning around her, the woman reported feeling an unusual blockage or pressure to her right. ear and also suffered from right-sided hearing loss.

Doctors performed a physical examination of the woman’s right ear, but found no abnormalities. The team then put the patient to a common test for vertigo, called the Dix-Hallpike test, and found she exhibited the telltale nervous eye movements that are often associated with such dizziness.

As an initial treatment, doctors guided the patient through an exercise designed to treat one of the most common forms of vertigo, known as “benign paroxysmal positional vertigo” (BPPV). This condition occurs when tiny crystals inside the inner ear detach from their normal position, according to Johns Hopkins medicine. These crystals, or “ear stones”, are usually found inside a sac-like organ in the ear that detects changes in the orientation of the head, but when the ear stones detach from this organ, they can trigger feelings of dizziness. An exercise called the Epley maneuver can put the ear stones back in their place, but in the woman’s case, the exercise didn’t help.

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The patient’s symptoms worsened over several days, so her doctors performed a follow-up exam, which included a CT scan of her right temporal bone, which surrounds the ear canal. This scan revealed air bubbles trapped in several structures of the inner ear. The condition of having gas caught in the inner ear is known as pneumolabyrinth and can cause symptoms of hearing loss and a feeling of “ear fullness”, as well as dizziness, the authors said.

Pneumolabyrinth most often occurs after some kind of head trauma, ear surgery, or temporal bone fracture, according to a 2021 review published in the journal European Archives of Oto-Rhino-Laryngology. However, the woman’s case was unusual in that she had no history of head trauma or fore ear surgery, her doctors reported.

The team theorized that somehow a spontaneous tear could have opened in the patient’s oval window – a thin membrane that separates the air-filled middle ear from the fluid-filled inner ear – although on examination they found no obvious abnormalities. in the middle ear. Despite this, the patient’s severe symptoms did not improve over the next week, so doctors decided to perform surgery to repair the presumably damaged oval window with a tissue graft.

This surgery “proved to be effective,” they reported. At a follow-up appointment shortly after surgery, the patient reported improvement in all of her symptoms. Two months later, his hearing was fully restored and a CT scan confirmed that there were no air bubbles left in his inner ear.

Originally posted on Live Science.

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