Electronystagmography: vestibular findings in a patient with tinnitus.

A 61-year-old woman came to the office with a chief complaint of tinnitus in her left ear of 5 years' duration. Its onset had been coincident with a sinus infection. When the infection cleared, the tinnitus disappeared for 7 months. The patient then experienced a recurrence of both the sinus infection and the tinnitus. She underwent revision surgery for her sinus problem, and the tinnitus had resolved for 3 months when the tinnitus returned, and it remained.

The patient described her tinnitus as a "jackhammer," a "striking," or a "hitting" sound. She was "also aware of a hearing loss in recent years, more so in her right ear. She reported no aural fullness. She also related that 3 years earlier, she had experienced a 1-week episode of intermittent periods when she was unable to stand up and felt nauseous. However, these symptoms had not recurred, and she said she had had no problem with her balance since.

Physical examination revealed that both tympanic membranes were scarred, a finding that was consistent with her history of childhood ear infections, which she also reported. She had difficulty performing the sharpened tandem Romberg's test, and she exhibited left nuchal tenderness. Audiology revealed a bilateral, mixed (but mainly sensorineural) hearing loss, with a greater conductive component on the right.

Electronystagmography elicited no spontaneous or positional nystagmus. The alternate binaural bithermal caloric test elicited a significant 63% reduced vestibular response (RVR) left. The simultaneous binaural bithermal test elicited a type 2 response with an RVR left. These findings were consistent with the side of both her tinnitus and nuchal tenderness. Ultrathin-section computed tomography of the temporal bones demonstrated evidence consistent with otosclerosis of the otic capsule, more so on the left.

She was prescribed etidronate and calcium carbonate and called back 4 months later. At the follow-up visit, she reported that her tinnitus had disappeared. Again, the electronystagmographic findings in this patient were consistent with the side on which her clinical symptoms appeared, although no lasting vestibular symptoms were present.