A patient with ear pain who had panic attacks while driving over bridges and in wide-open spaces. (Vestibulology Clinic).A 50-year-old woman had a 15-year history of symptoms, primarily aural fullness in the left ear. In addition, she had recently begun to experience pain in the left ear. Her hearing on the left had always been diminished, but it had not changed upon the recent onset of ear pain. She reported no tinnitus or dizziness. However, she did volunteer that she experienced panic attacks while driving over bridges and through wide-open spaces. She had undergone a tympanoplasty tympanoplasty /tym·pa·no·plas·ty/ (tim´pah-no-plas?te) surgical reconstruction of the tympanic membrane and establishment of ossicular continuity from the tympanic membrane to the oval window. in the left ear in 1977. One significant finding during the clinical examination was the presence to left nuchal nuchal (nyōōˑ·k  l),adj pertaining to the posterior or nape of the neck. tenderness. Also, the patient experienced difficulty performing the sharpened tandem Romberg's test. Audiology audiology /au·di·ol·o·gy/ (aw?de-ol´ah-je) the study of impaired hearing that cannot be improved by medication or surgical therapy. au·di·ol·o·gy n. revealed only a slight reduction in hearing the left ear, and tympanometry revealed no abnormal pressure in the middle ears. Electronystagmography detected no spontaneous, positional, or neck-torsion nystagmus Nystagmus Definition Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generally involuntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often, but not necessarily, a sign of . The alternate binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears. bin·au·ral adj. Having or relating to both ears. binaural pertaining to both ears. bithermal test showed a reduced vestibular response (RVR RVR Regionalverband Ruhr (Ruhr area, Germany) RVR Runway Visual Range RvR Realm Versus Realm (game) RVR Renal Vascular Resistance RVR Risk vs. ) on the left of 37%. The simultaneous binaural bithermal test found a type 2 response with an RVR left. Ear pain of the nature in the presence of an RVR is no unusual. It reflects the referral of the muscle spasm to the ear as a representation of the vestibulocollic reflex. The panic that the patient felt while driving was the result of the mismatch of inputs from the eyes and inner ears. The inability of the central mechanisms to compensate for the mismatch produced the feeling of panic. [GRAPH OMITTED] [GRAPH OMITTED] [GRAPH OMITTED] [GRAPH OMITTED] [GRAPH OMITTED] [GRAPH OMITTED] |
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