A mystery disease that caused a middle-aged woman to have room-spinning vertigo and partial hearing loss for more than a week was associated with small air bubbles piercing her inner ear.
In a case report, otolaryngologist Anthony DiPonio of the Henry Ford Macomb Hospital in Michigan and his colleagues detailed the unusual illness. After having a strong spinning sensation for 24 hours, along with hearing loss and a feeling of pressure in her right ear, the woman, 51, sought medical help. A physical examination of her right ear, on the other hand, revealed no obvious abnormalities.
The doctors then performed the Dix–Hallpike procedure, a normal test for benign paroxysmal positional vertigo (BPPV), a common type of vertigo.
BPPV is caused by a microscopic calcium crystal called otoconia becoming loose from the walls of the semi-circular canal in the inner ear, either as a result of a head injury or simply as a result of aging.
Otoconia are used to measure physiological acceleration because their weight and inertia tug on small sensory hairs linked to them via a fibrous membrane.
When these crystals become dislodged, they can slosh around in the semi-circular canal, fooling the inner ear into believing the body is moving or spinning when it is not.
The Dix–Hallpike test entails a movement that causes the errant crystals, known as “canaliths,” to shift around.
At this stage, the prescribing doctor can check for vertigo symptoms, such as nystagmus (repetitive, involuntary eye movements), which are a sign of dizziness.
The patient developed nystagmus after the test, according to the team.
In certain circumstances, a sequence of gradual head and neck motions dubbed the “Epley manoeuvre” can displace canaliths into a section of the ear where they are unable to cause vertigo — however, this did not work for the woman.
The doctors performed computed tomography (CT) scan of the woman’s right temporal bone, which covers the corresponding inner ear canal, some days later, when her symptoms had apparently increased.
This revealed the existence of small air bubbles trapped within several of the woman’s inner ear components, a disease is known as pneumolabyrinth.
Not only can this illness cause dizziness, but it can also cause hearing loss and a feeling of fullness or pressure in the ear.
Pneumolabyrinth usually develops after a head injury, but the woman’s case was uncommon in that she had no history of injury or prior ear surgery that could have caused the problem.
They said: “This patient presented with a spontaneous idiopathic cause of pneumolabyrinth.
“Given the focus of the air bubbles around the oval window in the labyrinth, it was presumed that either a spontaneous tear or disruption of the annular ligament of the stapes was involved.”
The stapes is a tiny, stirrup-shaped bone that carries sound energy over the oval window, which separates the air-filled middle ear from the fluid-filled inner ear.
After the woman’s symptoms did not improve in the next week, the surgeons performed surgery to replace the oval window’s — likely punctured — membrane with a tissue graft.
The procedure “proved to be effective,” according to the team, with the woman’s symptoms subsiding and a follow-up CT scan two months later showing “resolution of air in the labyrinth.”
The study’s findings were published in the JAMA Otolaryngology–Head & Neck Surgery.
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