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Updated 24 June 2015

Answer: What's your diagnosis? - 'The world is spinning'

In last week’s case, Mrs P, a 35 year old secretary, suddenly became very unsteady on her feet when it felt to her as if the world is spinning. Based on her history and examination the most likely diagnosis is labyrinthitis.

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Mrs P suffered a sudden onset of vertigo in our latest case. Read the full case study here.

In Mrs P’s history, it is very important to note that she feels as if “the world is spinning”, but not “lightheaded” (where it feels as if the person is walking on a cloud, but the surroundings are not spinning). This is important to note because lightheadedness is usually persistent (as long as the cause is still present) while vertigo involves transient, but recurrent episodes.

With labyrinthitis the nerves in your inner ear that control your sense of position become inflamed. This can be caused by an infection of the upper respiratory tract like flu or ear infections.

Reduced hearing

Making the case more complicated is the fact that Mrs P also reported a ringing sound in her left ear and occasional reduced hearing in the same ear. This is in keeping with Meniere’s disease – a condition where the fluid volume in the inner ear is high, due to, for example, abnormal drainage or virus infections.

The exact details of how this disease is caused are still unknown. With Meniere’s disease it is important to remember that it can become a chronic condition that can last for weeks or even months. Labyrinthinits usually clears within about a week. 

With middle ear infections, patients can also experience a feeling of being off-balance, but in Mrs P’s case a middle ear infection is unlikely as this is usually accompanied by pain.

Making a definite diagnosis in this case is not straight forward, as there are many factors involved. Based on her history and examination findings, an exact diagnosis cannot be made as the timeframe of her symptoms is too short to exclude a potentially chronic condition like Meniere’s.

The viral illness, that Mrs P experienced a week or so before the onset of her vertigo episodes, makes labyrinthitis the more likely diagnosis.

Vertigo is unpredictable

Conditions associated with vertigo should not be taken lightly as the onset of a vertigo episode can’t be predicted and can happen while driving or working at a height.

Treatment depends on the cause, but with Miniere’s disease and labyrinthitis there are no known cures. Doctors will often treat the symptoms and prescribe medicines to ease the nausea and vomiting. Medicines like meclizine, used in treating motion sickness, may ease the vertigo symptoms.  In very severe cases surgical options are available. 

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? – Case 1: vomiting and weight loss

What's your diagnosis? – Case 2: eye pain

What's your diagnosis -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10:diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

What's your diagnosis - Case 13: severe sore throat

Image: woman suffering from vertigo from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.

 
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