Case Study: Recurrent Vertigo and Auditory Symptoms in a Postpartum Female
Case at a Glance
A 29-year-old female, 10 months postpartum, presents with a 6-month history of recurrent, debilitating vertiginous episodes accompanied by unilateral auditory symptoms, prompting concern for an underlying condition beyond an initial diagnosis of Benign Paroxysmal Positional Vertigo (BPPV).
Patient's Story
The patient is a 29-year-old female who began experiencing episodic dizziness approximately four months after childbirth. Over the past six months, she has had episodes of intense dizziness lasting about a week, occurring one to two times per month. The vertigo is severe at the onset, causing significant imbalance to the point of running into walls. While worsened by head movements, it can also occur spontaneously. Accompanying these episodes are left-sided aural fullness, an occasional ache in the left ear, sinus-type headaches, and nausea. Between episodes, she experiences persistent tinnitus, which she describes as a 'post-concert ringing' in quiet environments, and subjective hearing loss, noting an increased need to ask others to repeat themselves. A family history of Meniere's disease in her mother contributes to her anxiety about the diagnosis.
Initial Assessment
The patient initially sought care at an after-hours clinic during her first episode and was diagnosed with BPPV. During a subsequent episode, she presented to a practitioner at her usual clinic after attempting to relieve aural fullness by cleaning her ear, which resulted in a 'pop' followed by bleeding. Examination at that time revealed an inflamed ear canal with a visible clot, and she was diagnosed with traumatic otitis externa. She was prescribed antibiotic/antifungal ear drops, oral antihistamines, and a nasal spray. The efficacy of this regimen was difficult to assess due to the episodic nature of her symptoms. Most recently, she consulted her primary GP about another episode, expressing concern that the Epley maneuver did not provide relief and that her symptoms extended beyond typical BPPV. She was prescribed prochlorperazine (Stemetil) for symptomatic relief without a direct ear examination.
The Diagnostic Journey
The patient's clinical picture presents a classic triad of vertigo, tinnitus, and aural fullness, which is inconsistent with a simple BPPV diagnosis. The positional nature of the vertigo initially suggested BPPV, and maneuvers for the left side did provoke symptoms, but they failed to resolve the condition. The persistent tinnitus, subjective hearing decline, and strong family history of Meniere's disease are significant red flags. The patient's self-reported hearing difficulties warrant objective assessment. In online consultation, a physician recommended a specialist evaluation, citing concern for Meniere's disease.
Final Diagnosis
A definitive diagnosis has not yet been established. The leading differential diagnosis is Meniere's disease, given the constellation of episodic vertigo, fluctuating aural symptoms (fullness, tinnitus), and subjective hearing loss, along with a positive family history. Other considerations include vestibular migraine, though the prominent auditory symptoms make Meniere's a higher suspicion.
Treatment Plan
Current management is purely symptomatic with as-needed prochlorperazine for vertigo. The patient plans to request a formal referral to an Ear, Nose, and Throat (ENT) specialist for a comprehensive workup. This evaluation should include a detailed history, neurotologic examination, and formal audiometry to quantify any hearing loss. Further vestibular function tests may be indicated to confirm the diagnosis.
Outcome and Follow-up
The patient intends to see her GP during the next flare-up to secure an ENT referral. The immediate goal is to undergo specialist evaluation to establish a correct diagnosis, which is crucial for developing an effective, long-term management strategy to control her symptoms and address her concerns about a progressive condition.