A patient with M[acute{e}]ni[grave{e}]re's syndrome: Ear-under nystagmus is opposite of clinical findings; caloric result shows directional preponderance

Ear, Nose & Throat Journal, April, 2000 by Kenneth H. Brookler

A 55-year-old man came to the office with a history of tinnitus in the right ear of 5 years' duration and episodic vertigo for 2 years; the vertiginous episodes had increased in frequency and severity over the previous 8 weeks. Prior to the onset of his dizzy spells, the patient had experienced a fluctuating hearing loss and intermittent aural fullness in the right ear. The family history was positive for hearing loss. The man was also hypercholesterolemic, and he had undergone coronary artery bypass surgery.

From Neurotologic Associates, P.C., New York City.

Electronystagmography showed a left-beating nystagmus in the left lateral position. The caloric nystagmus was not "clean," but the direction and velocity of the nystagmus was appreciated. There was a 27% directional preponderance to the right and a 0% reduced vestibular response. The simultaneous bilateral bithermal response revealed a type 3 left-beating nystagmus. While the caloric results are not localizing, these results are consistent with a peripheral vestibular disorder.