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Electronystagmography: Dizziness and syncope.

A 77-year-old woman came to the office and said that she felt she had been "on a ship" during the preceding 6 weeks. This feeling occurred regardless of whether she was lying down, sitting, standing, or walking. Nothing made her feel either better or worse. About 2 weeks prior to her visit, she had been found unconscious. She believed that this was related to a combination of her dizziness and diabetes.

She had been admitted to the hospital, but no cause of syncope was found. She had had a binaural hearing loss for 15 years, for which she used amplification. She also had a 20-year history of tinnitus capitis, which is a high-pitched whistle sound in the middle of the head. The tinnitus was unaffected by her recent dizziness.

Electronystagmography revealed no spontaneous, positional, or neck torsion nystagmus. She had difficulty staying awake during the caloric portion of the testing, which resulted in dysrhythmic patterns on all caloric tracings. The alternate binaural bithermal test was normal, with a 14% reduced vestibular response (RVR) on the right and a 6% directional preponderance to the right. The simultaneous binaural bithermal test revealed a type 2 response with an RVR on the right.

The day after the electronystagmography, her dizziness disappeared. She believed that the caloric testing had induced the remission of her symptoms. On rare occasions, routine electronystagmography can induce a remission of the vestibular symptoms under investigation. This is believed to be the result of a caloric-induced central compensation, not unlike the focus of vestibular habituation therapy and canalith repositioning.

From Neurotologic Associates, P.C., New York City.
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Article Details
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Author:Brookler, Kenneth H.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Sep 1, 2000
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