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Electronystagmography in a patient with a peripheral vestibular disorder.

A 29-year-old man had a 2-year history of dizziness. It began after he experienced a head cold. When he blew his nose, he felt a pop in his left ear, which was followed by severe dizziness and later nausea. This lasted for 2 or 3 weeks. The dizziness was so severe for a few days that he could not move in any direction, did not know which way was up, and had no equilibrium. When the dizziness was less severe, he felt pressure under both eyes and had a lightheaded feeling. He had experienced occasional lightheadedness for about 2 years before the onset of this dizziness.

When he came to the office, he was wearing a scopolamine scopolamine (skōpŏl`əmēn, –mĭn) or hyoscine (hī`əsēn', –sĭn), alkaloid drug obtained from plants of the nightshade family (Solanaceae), chiefly from henbane,  patch, which allowed him to function normally. He took 25 mg of meclizine meclizine /mec·li·zine/ (mek´li-zen) an antihistamine used as the hydrochloride salt as an antinauseant in motion sickness and to manage vertigo associated with disease affecting the vestibular system.  as needed. He had tried hydrochlorothiazide and corticosteroids without benefit. He reported no tinnitus, hearing loss, or aural fullness. His family history included hearing loss in both parents, one of whom had been diagnosed with otosclerosis otosclerosis: see deafness. . He was on a low-salt diet. A contrast-enhanced MRI was negative, and his auditory brainstem response was normal.

On electronystagmography, there was a spontaneous 6[degrees]/sec left-beating 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
. This nystagmus was found in all positions (supine, right and left lateral, and neck torsion). There was no evidence of a fistula sign on either electronystagmography or acoustic immittance Immittance

The impedance or admittance of an alternating-current circuit. It is sometimes convenient to use the term immittance when referring to a complex number which may be either the impedance (ratio of voltage to current) or the admittance (ratio of
 bridge testing. The tracing was not clear in places, which indicated a possible inadequate electrode coupling. The caloric responses were corrected for the pre-existing nystagmus. The reduced vestibular response was 7%, and the directional preponderance was 20% to the right. The simultaneous binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears.

Having or relating to both ears.


pertaining to both ears.
 bithermal showed a type 2 response, with the pre-existing left-beating nystagmus reduced by 3%/sec of induced right-beating nystagmus. This revealed a reduced vestibular response left.
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Author:Brookler, Kenneth H.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 1, 2000
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