Patient 3

April 28th 2012

I woke up at 11.45 p.m. with severe nausea, vomiting and rotary vertigo. It would not stop, so I was taken to X Hospital where I stayed for three days. I was given a drug to stop the vomiting and was put on a drip to counteract dehydration.

I was expecting the vertigo to stop, as the nausea and vomiting had already done so. However it did not and eventually I was referred to Mr Rejali.

26th June 2012

An initial consultation was made with Mr Rejali.

6th July 2012

Mr Rejali removed the wax that had built up in the right ear. He was able to diagnose right vestibular neuritis and Bilateral posterior canal BPPV (F5611/F5612)

He performed the Epley Manoeuvre.

He made a further appointment with the Ear Care nurse.

I felt very unsteady and there was still rotary vertigo, but delayed for several seconds.

27th July 2012

Mr Rejali performed the Epley Manoevre twice for the left side as the nystagmus continued.

I still felt unsteady on walking. I still had difficulty with escalators etc.


An appointment with the Ear Care Nurse. She did not observe any nystagmus when I laid down. It was present however.

3rd September 2012

BPPV more noticeable today. Epley Manoevre performed twice on right side.

Brandt Daroff exercises started.

1st October

Positional tests on the left showed torsional geotropic nystagmus which did not fatigue or reverse on sitting up.

On the right had a more typical BPPV.

Migrainous headaches mentioned. Atypical migrainous process.

Referred to Dr X for further assessment.

'Heal your headache' book read. General advice good, but dietary advice already adhered to.

9th November

MRI scan of inner ear

MRI scan of headCarried put at X Hospital.

28th November

Appointment with Dr X at University Hospital Coventry.

Dr X team member was not able to view the scans done at Heartlands Hospital


Letter from Mr Rejali saying no significant abnormality was shown by the MRI scans.

2nd February 2013

Episodic vertigo and unsteadiness. Right posterior canal BPPV.

Some features of central positioning nystagmus.

Some evidence of visual vertigo.

Advised to continue with Brandt Daroff exercises and optokinetic stimulation with a disco ball.

No further follow-up recommended.

My thoughts

It has taken far longer than I had originally hoped for my symptoms to recede. It is now 11 months since the onset.

Mr. Rejali warned me that in some cases the symptoms would take a long time going - or in fact would never completely clear. I chose not to listen to that!

I had previously been in fairly good health and had enjoyed a very active life. I am now restricted to what I can take on. Tiredness and stress makes the symptoms soon become more active.

I am still a bit unsteady. I prefer a wall to be at hand, failing that I hold on to my husband for reassurance. I feel as if I am a bit tipsy, though I am not!

I tried the disco ball, but it was hard to get the room dark enough for the full effect. The ball gives off its own light. Perhaps I did not persevere with it long enough, but I did not feel uncomfortable with the lights moving across the room.

The Brandt Daroff exercises were very useful.

The spinning sensation hardly ever happens now (though it is tempting fate to write this down), even when I lie down at night.

I am left with a certain unsteadiness and accompanying lack of self confidence.

The computer movements between the screen and keyboard still affect me adversely. They create a feeling of pressure and almost spinning. Thank goodness for this iPad where the keyboard is part of the screen and requires no head movements.

I have been able to return to driving the car, first with my husband in the passenger seat, and then alone. This has the advantage of giving me back my independence, which I sorely missed. I have to pace myself - for instance I used to drive for one and a half hours to see our grandchildren and return the same day. This is now difficult. If I am driving with my husband, we take turns for half the journey. If I am on my own, I stay overnight.

After having had to cancel several holiday breaks last year, because I was feeling unwell, we have recently spent 7 days in X. We know the hotel and the island very well, so it felt safe and secure.

The flight did not trouble me as much as I thought it might. The sensation of lift-off was very similar to the feeling of pressure that I frequently experience. Once we were in the air I experienced no problems.

The hotel had a spiral open staircase of marble to the dining room. I tried this only once. The remainder of the time I took the lift. It was the open-ness of the staircase and the slippery steps that were the problem, even though a handrail was provided.

I rested most afternoons, something that seems difficult to achieve at home.

All in all, a success.

I feel I do not need more consultations, as I have learnt to accommodate to the symptoms. They are getting steadily less, though I have to be sure not to put too much pressure on myself.

I appreciate Mr Rejali's care. He was not afraid to say that the symptoms puzzled him, and he was able to suggest good ways of coping. He tried the Epley Manoevre, and the Brandt Daroff exercises, which gave some relief. The disco ball and the 'Heal your Headache' book were an interesting option, but did not give as effective relief.