Woman's sudden dizziness and hearing loss had a rare cause

Air bubbles trapped in a woman's inner ear caused her to develop severe dizziness, seemingly out of nowhere, and she required surgery to make the disorienting, spinning sensation go away.

The 51-year-old woman initially went to the doctor after experiencing this strange spinning sensation for about 24 hours, according to a report of the case published Thursday (April 21) in the journal JAMA Otolaryngology–Head & Neck Surgery. In addition to feeling as though the room were spinning around her, the woman reported that she felt an unusual blockage or pressure in her right ear and was also experiencing right-sided hearing loss. 

The doctors performed a physical examination of the woman's right ear, but they found no abnormalities. The team then ran the patient through a common test for vertigo, called the Dix-Hallpike test, and found that she exhibited the telltale twitchy eye movements that are often associated with such dizziness. 

As an initial treatment, the doctors led the patient through an exercise designed to treat one of the most common forms of vertigo, known as "benign paroxysmal positional vertigo" (BPPV). This condition occurs when tiny crystals inside the inner ear become dislodged from their normal position, according to Johns Hopkins Medicine. These crystals, or "ear stones," typically sit inside a sac-like organ in the ear that detects changes in the head's orientation, but when the ear stones detach from this organ, they can trigger sensations of dizziness. An exercise called the Epley maneuver can move the ear stones back into their proper place, but in the woman's case, the exercise didn't help.

Related: Woman develops horrifying skull infection after cleaning her ears with cotton swabs 

The patient's symptoms worsened over the course of several days, so her doctors conducted a follow-up examination, which included a CT scan of her right temporal bone, which surrounds the ear canal. This scan revealed air bubbles trapped in several structures of the inner ear. The condition of having gas caught in the inner ear is known as pneumolabyrinth and can cause symptoms of hearing loss and a sensation of "ear fullness," as well as dizziness, the authors said.

Pneumolabyrinth most commonly occurs after some sort of head trauma, ear surgery or temporal bone fracture, according to a 2021 review published in the journal European Archives of Oto-Rhino-Laryngology. However, the woman's case was unusual in that she had no history of traumatic head injury nor any prior ear surgery, her doctors reported. 

The team theorized that, somehow, a spontaneous tear may have opened in the patient's oval window — a thin membrane that separates the air-filled middle ear from the fluid-filled inner ear — although upon examination, they didn't find any obvious abnormalities in the middle ear. Despite this, the patient's severe symptoms failed to improve over the following week, so the doctors decided to perform a surgical procedure to repair the presumably damaged oval window with a tissue graft. 

This surgery "proved to be effective," they reported. At a follow-up appointment soon after the surgery, the patient reported improvements in all of her symptoms. Two months later, her hearing had fully recovered, and a CT scan confirmed that there were no air bubbles left in her inner ear.

Originally published on Live Science.