Persistent alternobaric vertigo at ground level

Authors

  • Charles D. Bluestone MD,

    Corresponding author
    1. University of Pittsburgh School of Medicine, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
    • Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion, Floor 7, Pittsburgh, PA 15224
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  • J. Douglas Swarts PhD,

    1. University of Pittsburgh School of Medicine, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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  • Joseph M. Furman MD, PhD,

    1. Departments of Otolaryngology, Neurology, Bioengineering and Physical Therapy, University of Pittsburgh School of Medicine, Division of Balance Disorders, Eye and Ear Institute of Pittsburgh, Pennsylvania, U.S.A
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  • Robert F. Yellon MD

    1. University of Pittsburgh School of Medicine, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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  • Presented in part at the 10th International Symposium on Recent Advances Otitis Media, New Orleans, Louisiana, U.S.A., June 7, 2011.

Abstract

We recently encountered a 15-year-old female with bilateral tympanostomy tubes who manifested persistent severe vertigo, at ground level, secondary to a unilateral middle-ear pressure of +200 mm H2O elicited by an obstructed tympanostomy tube in the presence of chronic nasal obstruction. We believe this is a previously unreported scenario in which closed-nose swallowing insufflated air into her middle ears, resulting in sustained positive middle-ear pressure in the ear with the obstructed tube. Swallowing, when the nose is obstructed, can result in abnormal negative or positive pressures in the middle ear, which has been termed the Toynbee phenomenon. In patients who have vertigo, the possibility that nasal obstruction and the Toynbee phenomenon are involved should be considered. Laryngoscope, 2012

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