A peculiar case of hearing loss followed years later by tinnitus and vertigo

Vestibular paroxysmia (also known as disabling positional vertigo) is a clinical syndrome generated by a symptomatic neurovascular compression of the eighth cranial nerve. Although doubted by some authors, this syndrome must be suspected in presence of brief spells of positional vestibular symptoms associated with temporary or permanent but worsening cochlea-vestibular symptoms and signs, not explained by other diseases. We report a case of a 20-year-old girl affected by permanent sensorineural hearing loss on the right since the age of 4-5 years, who subsequently developed intermittent low pitch tinnitus on the right ear and spells of vertigo or dizziness generated by position or physical activity. Angio-MRI of the brain showed a singular neurovascular contact between the right vertebral artery and the right eighth cranial nerve. The excellent response to carbamazepine confirms the presence of this syndrome.