Unusual vertigo can be triggered by coughing or loud noises

DEAR DR. ROACH » After many years of various treatments, including allergy shots, food studies and an ear tube, I was recently diagnosed with “semicircular canal dehiscence.” Can you explain what this is and the treatment (besides surgery) to relieve the symptoms of inner ear pressure, dizziness and pressure and pulsation in the head? Are there any medications? DEAR READER » Semicircular canal dehiscence syndrome is an unusual cause of vertigo. Vertigo is sometimes referred to as dizziness, but “dizziness” may refer to both unsteadiness (a feeling that you are going to pass out, which medically is referred to as “presyncope”) or true vertigo (a sensation of movement when the person is actually still). The vertigo in semicircular canal dehiscence syndrome is different from most other causes of vertigo because it can be provoked by loud noises, coughing or sneezing. It is caused by abnormally thin bone in the semicircular canals, part of the organ of balance in the inner ear. The diagnosis is confirmed by a CT scan of the temporal bone.

The only treatment I have read that consistently is effective is surgery. An ear tube is sometimes tried in people who have symptoms with pressure changes. Medications used in some cases of vertigo, such as meclizine (Antivert), usually will make SCDS symptoms worse in the long term. Anti-nausea medications like ondansetron (Zofran) may help if nausea is severe, but have their own side effects. Vestibular rehabilitation by a specially trained physical or occupational therapist may have some benefit if surgery isn’t contemplated.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.