Electronystagmography in a patient with a sudden unilateral sensorineural hearing loss.A 33-year-old woman presented with a history of aural symptoms. On two or three occasions just over 2 years ago, she had experienced a transient hearing loss in the left ear with associated aural fullness and tinnitus Tinnitus Definition Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head. . These episodes took 2 to 3 days to clear up. At about the same time, she also experienced recurrent spells of rotary vertigo with nausea, vomiting, and headaches. When the patient was 7 months into her most recent pregnancy--11 months prior to her presentation-she noted aural fullness in both ears. Toward the end of the pregnancy, she noted a recurrence of her hearing loss and tinnitus in the left ear. Since then, the intensity of the left-sided tinnitus and the bilateral aural fullness had diminished somewhat, but her hearing had not improved. She had earlier received two intratympanic injections of a corticosteroid corticosteroid /cor·ti·co·ster·oid/ (-ster´oid) any of the steroids elaborated by the adrenal cortex (excluding the sex hormones) or any synthetic equivalents; divided into two major groups, the glucocorticoids and without subjective improvement. A tuning fork test revealed that the hearing loss in the left ear was severe. The right ear was normal. Findings on the standard Romberg's test were normal, but the patient experienced a marked amount of difficulty performing the sharpened tandem Romberg's test with the left foot forward and somewhat less difficulty with the right foot forward. Electronystagmography revealed a brisk, direction-fixed, right-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 that ranged from 8[degrees]/sec to 15[degrees]/sec, depending on the position. The alternate bithermal caloric tests were not corrected for the preexisting pre·ex·ist or pre-ex·ist v. pre·ex·ist·ed, pre·ex·ist·ing, pre·ex·ists v.tr. To exist before (something); precede: Dinosaurs preexisted humans. v.intr. nystagmus. With a preexisting right-beating nystagmus ranging up to 15[degrees]/sec, a warm stimulus to the left ear could not produce a 27[degrees]/sec fight-beating nystagmus. This finding suggested a much greater range of fluctuation in the spontaneous nystagmus. The simultaneous 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 was not corrected for the preexisting nystagmus, and it elicited a type 2 response--that is, a reduced vestibular response left that was consistent with a left peripheral vestibular disorder peripheral vestibular disorder Neurology A hallucination of movement, either subjective or objective History Duration of an attack–eg, hrs v. days, frequency daily v. . This was achieved by a reversal of the right-beating nystagmus with the simultaneous cool (30[degrees]C) stimulus. These electronystagmographic findings are quite striking in a patient who had had no vestibular symptoms for 2 years. Despite these findings, her central neural compensatory mechanisms compensatory mechanisms Cardiac pacing Physiologic responsiveness of cardiovascular system whereby it changes its function and characteristics to ↑ or ↓ cardiac output. See Cardiac output. were able to adapt to this fluctuating, mismatched peripheral vestibular stimulation. Brookler, Kenneth H. From Neurotologic Associates, PC, New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . |
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