Adult Patient with Chronic Otitis Media and Recurrent Benign Paroxysmal Positional Vertigo
ES was referred for audiologic testing by his primary care physician due to ES’s reports of hearing difficulties. These reports included difficulty hearing, “no right eardrum,” and occasional dizziness. A report from a previous otolaryngology visit indicated that ES had a history of chronic otitis media with malodorous otorrhea and this condition is aggravated when he has upper respiratory infections (URI) that occur four to five times a year. ES was also previously evaluated by neurology for severe dizziness and stroke. At that time, ES underwent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of his head because of his history of a stroke and to rule out retrocochlear pathology as a cause of his dizziness. The imaging studies reported no acute infarct, hemorrhage, or vestibular schwannoma. Through additional questioning and administration of the Dix–Hallpike maneuver, neurology determined ES’s dizziness was positional in nature (i.e., Benign Paroxysmal Positional Vertigo [BPPV]). As a result of this diagnosis, several canalith repositioning maneuvers (i.e., Epley maneuvers) were performed in the neurology clinic that reduced ES’s dizziness. ES also reports a long history of exposure to noise having been employed at a welding factory for 5 years. He also reports constant bilateral tinnitus that is longstanding, yet manageable. Finally, ES reports additional pertinent health conditions that include hypertension, Hepatitis C, and expressive aphasia secondary to his stroke.