Benign Paroxysmal Positional Vertigo Caused By Swimming

Benign paroxysmal positional vertigo (BPPV) is characterized by mechanical dysfunction of the vestibular system in the inner ear. Displacement of otoconia from utricle to semicircular canals is held responsible for the development of BPPV. Etiologic factors are mostly classified as idiopathic. Head trauma, viral labyrinthitis and otologic surgery are also included [1,2]. A 58 year old, female patient was admitted to Ear Nose Throat Clinic with sudden onset of vertigo and nausea. In her detailed history, she had had a long-term swimming activity just before the onset of symptoms. She reported that her house is on the seaside in Antalya, and she swims as a recreational activity for 3-5 days/week every summer. She had been using the freestyle swimming technique (front crawl) and rotating her head to the left for breathing. Different from previous swimming sessions, she had swam faster at the last session. She did not have a history of head injury, upper respiratory tract infection or drug usage that affect the vestibular system in the last 2-3 weeks. Otoscopic examination was normal. Head shake, head thrust and Romberg tests were positive. Dix-Hallpike test was positive on the right side. During the test, horizonto-rotatuar nystagmus with latency period was observed. Other neurological examination findings were normal. Pure tone audiometry and tympanometry tests showed normal values. There was no limited range of motion of the neck. The patient was diagnosed as BPPV. There was no need for imaging of central nervous system because the Dix-Hallpike test was positive (peripheral vertigo) and neurological examination was greatly normal. Right Epley maneuver was performed for therapeutic approach (1 session). The patient's symptoms dramatically declined after the particle repositioning maneuver. In addition, the patient was referred to Sports Medicine Clinic for recommendations about the swimming sport. In order to prevent the possible recurrence, it was recommended to mainly use the backstroke style in which the head is in a more fixed position. It was also told to her that she should avoid rapid head movements during stroke, and should breathe on both sides while swimming in freestyle. Additionally, " ear band " was advised to use. After two weeks, she was able to return to swimming. After 12 months, the patient was called by phone. There was no symptomatic recurrence in 1 year. She could continue swimming activity without any problem in the subsequent summer. There are various studies in the literature showing the …