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Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm
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Persistent alternobaric vertigo at ground level.

Charles D Bluestone1, J Douglas Swarts, Joseph M Furman

  • 1University of Pittsburgh School of Medicine, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224, USA. bluecd@chp.edu

The Laryngoscope
|February 2, 2012
PubMed
Summary
This summary is machine-generated.

A case of severe vertigo in a teen with ear tubes was linked to nasal obstruction. Swallowing with a blocked nose caused pressure buildup in the middle ear, leading to the vertigo.

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Area of Science:

  • Otolaryngology
  • Neurology
  • Vestibular System

Background:

  • Tympanostomy tubes are used to treat middle ear issues.
  • Nasal obstruction can affect middle ear pressure.
  • The Toynbee phenomenon describes pressure changes during swallowing with nasal obstruction.

Observation:

  • A 15-year-old female with bilateral tympanostomy tubes presented with severe vertigo.
  • She had chronic nasal obstruction.
  • One tympanostomy tube was obstructed, leading to sustained positive middle ear pressure (+200 mm H2O).

Findings:

  • Closed-nose swallowing insufflated air into the middle ear, causing positive pressure in the ear with the obstructed tube.
  • This sustained positive middle ear pressure was identified as the cause of the vertigo.
  • This represents a previously unreported scenario linking these factors.

Implications:

  • Nasal obstruction and the Toynbee phenomenon should be considered in patients presenting with vertigo.
  • This case highlights the complex interplay between the upper airway, middle ear, and vestibular system.
  • Understanding this mechanism can aid in diagnosing and managing vertigo in specific patient populations.