Vestibular findings in a young woman who developed dizziness and nausea following an airplane flight

Ear, Nose & Throat Journal, Dec, 2004 by Kenneth H. Brookler

A 23-year-old woman presented with a chief complaint of dizziness of 4 months' duration. Her symptoms began after she had taken an airplane trip. She had not experienced any problem with her ears during the flight and landing. Shortly afterward, however, she began to experience a light-headed feeling, slight dizziness, pressure in her head, and slight nausea. When her symptoms began in the morning, they would last for approximately 1 hour. When her symptoms began in the afternoon, they would last until she went to sleep. Not all of her episodes included head pressure and nausea. During the first month, she experienced 15 episodes; her attacks became daily during the next 2 months. During the fourth month, she began to feel as if she would pass out while walking; this feeling was different from the feeling she experienced during her original bouts of dizziness. She reported no hearing loss, tinnitus, or aural fullness. She had been taking oral contraceptives for 9 months.

Findings on clinical examination were normal except during the sharpened tandem Romberg's test, when the patient experienced slight difficulty with the right foot forward. When she stood on foam, her difficulty became quite apparent with either foot forward.

Electronystagmography detected no spontaneous, positional, or neck-torsion nystagmus. The alternate binaural bithermal caloric test elicited a 0% reduced vestibular response and a 0% directional preponderance. The simultaneous binaural bithermal stimulus elicited a type 4 response, with a marked left-beating nystagmus during simultaneous cool stimulus.

The features of this case are typical of an evolving vestibular problem that becomes symptomatic only as a result of the acceleration associated with air travel. Symptoms generally continue for a variable period of time until central compensation takes over and the symptoms decrease. A vestibular abnormality becomes apparent only on simultaneous cool stimulation, when there is an asynchronous input from the vestibular labyrinths sufficient to stimulate the medial longitudinal fasciculus to produce nystagmus. Without this testing, this patient's vestibular function might have been considered to be normal, and her symptoms might have been erroneously attributed to psychological factors.

Kenneth H. Brookler, MD

From Neurotologic Associates, PC, New York City.