Vestibular findings in a 30-year-old woman with disabling dizziness following childbirth.

A 30-year-old woman presented with a chief complaint of dizziness of 7 months' duration. She described her symptoms, which first manifested 6 weeks after she gave birth, as a feeling of being light-headed, off balance, and very shaky. She was also nauseated. She reported pressure in both ears but no tinnitus or hearing loss.

Another physician had treated her with antibiotics and an antihistamine without benefit. She was later diagnosed with myofascial pain syndrome and treated with a night guard, again without benefit. She later underwent audiometry and electronystagmography (ENG). As a result of these tests, she was told that she had an "inner ear disturbance that would go away with exercises of the head." She also tried meclizine without benefit.

Her symptoms eventually diminished for a 3-month period to the point that she was able to drive, but she still experienced some light-headedness. However, she later began to experience bitemporal and forehead headaches that were accompanied by nausea. Findings on a neurologic examination and magnetic resonance imaging were normal.

By the time she presented to the author's office, she was again unable to drive. She reported pain in both ears and intermittent clogging. She also became aware of hyperacusis. She was bothered most by the ear pressure and the off-balance feeling that occurred once she was out of bed. The feelings of pressure in her ears and shakiness were determined to be premenstrual symptoms. Her nausea might have been movement-induced.

Clinical examination revealed only that the patient had difficulty performing the sharpened tandem Romberg's test. Her earlier ENG report was available, and it was negative. There were no tracings to examine.

A second ENG elicited no spontaneous, positional, or neck-torsion nystagmus. The alternate binaural bithermal (ABB) stimulus reflected a 25% reduced vestibular response (RVR) right and a 6% right directional preponderance (DP). These findings are within the norms ([less than or equal to] 30%) established for both. The simultaneous binaural bithermal (SBB) caloric test elicited a type 2 response with an RVR left.

Ultrathin computed tomography (CT) of the temporal bones detected evidence of otosclerosis in both ears, more so on the left.

The patient's history of dizziness beginning shortly after childbirth and becoming worse premenstrually, as well as the CT findings of otosclerosis, are consistent with a diagnosis of otosclerosis. The results of the ABB test suggested a right-sided lesion, but her RVR of 25% did not rise to the 30% level of significance. The SBB test reflected the asynchrony of the information coming into her brainstem, which suggested a left-sided lesion.

Findings on audiometry were normal, but metabolic testing revealed an exaggerated response of blood glucose and evidence of hyperinsulinemia on a 5-hour glucose tolerance test. The patient was placed on sodium fluoride and calcium carbonate and referred for nutritional counseling. One month later, she reported that she was free of symptoms.

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From Neurologic Associates, PC, New York City.