Alternobaric vertigo in a patient on positive airway pressure therapy

Area of Science:

• Otolaryngology
• Sleep Medicine
• Neurology

Background:

• Continuous positive airway pressure (CPAP) is a standard, safe therapy for obstructive sleep apnea (OSA).
• While generally well-tolerated, CPAP use can lead to various complications, including sinus infections, bronchitis, ear pain, nasal congestion, and mucosal dryness.
• Previous reports indicate a rare association between positive airway pressure (PAP) therapy and symptoms of hearing loss and vertigo.

Observation:

• This report details a rare case of alternobaric vertigo occurring in a patient undergoing CPAP therapy for OSA.
• The patient experienced vertigo, a symptom previously documented in conjunction with PAP therapy.

Findings:

• A rare case of alternobaric vertigo secondary to CPAP use is presented.
• This contrasts with a single prior report of hearing loss and vertigo during PAP treatment, which resolved upon discontinuation.
• Crucially, re-challenging the patient with CPAP at gradual increments was not previously reported.

Implications:

• This case highlights the potential for rare otologic complications like alternobaric vertigo with CPAP therapy.
• It suggests that careful, incremental re-introduction of CPAP may be a viable strategy for patients experiencing such adverse effects.
• Further investigation into managing CPAP-induced vertigo and optimizing patient tolerance is warranted.