Electronystagmography in a woman with aural fullness, hyperacusis, and dizziness. (Vestibulology Clinic).

A 46-year-old woman came to the office with a 6-month history of a constellation of symptoms. Her primary symptom was aural fullness on the right that she thought had been brought on by her use of a cordless telephone and/or the clanging of dishes and silverware. Approximately 7 months earlier, she had gone through a 1-week period of dizziness in which she felt that her visual environment was "shaking." Accompanying her dizziness was a feeling of panic. She had no history of subjective hearing loss or tinnitus, but her family history was positive for hearing loss.

Neurotologic examination revealed that she had a hypersensitivity to the sound emitted by a low-frequency tuning fork in the right ear, and she exhibited difficulty performing the sharpened tandem Romberg's test. Audiometry revealed that her hearing in both ears was normal. Electronystagmography elicited no spontaneous or positional nystagmus, and her responses to the alternate binaural bithermal caloric test were normal. However, the simultaneous binaural bithermal test elicited a type 2 response with a reduced vestibular response right, a finding that was consistent with the aural fullness on that side. Her cholesterol level was elevated, and 5-hour glucose tolerance testing revealed an exaggerated blood-sugar response and an elevated insulin level. Findings on ultrathin-section computed tomography of the temporal bones were consistent with labyrinthine capsule otosclerosis. The patient was placed on a diet to address her metabolic factors and a bisphosphonate and calcium to address the otosclerosis.

On follow-up 4 months later, she exhibited little change in her symptoms, although there was some improvement in her very-high-frequency hearing. She returned again 4 months later and reported that she had felt well until she discontinued her treatment regimen. She also noted the return of severe dizziness that progressed to some imbalance. Also, hyperacusis returned in the right ear. She was switched to a newer bisphosphonate: residronate. She returned 3 months later and volunteered that she felt best when she followed her diet, but that she was not consistently compliant with it.

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