A 34-Year-Old Man Comes to the Office Due to Intermittent

A 34-year-old man comes to the office due to intermittent dizziness over the past 3 months.  The patient has had episodes of a sudden spinning sensation, accompanied by nausea, that resolve spontaneously after approximately a minute.  Symptoms occur when he is lifting heavy weights, riding on an elevator, or after sneezing.  He has had no headache or ear pain but has trouble hearing out of the right ear.  The patient had a concussion after a bicycle collision 4 months ago but has no other medical conditions and has had no recent upper respiratory illness.  Vital signs are within normal limits.  Physical examination shows normal ears, including tympanic membranes.  There is no extremity weakness or sensory loss.  No nystagmus is present at rest but performing a Valsalva maneuver provokes nystagmus and the other reported symptoms.  Which of the following is the most likely diagnosis?

A) Benign paroxysmal positional vertigo
B) Eustachian tube dysfunction
C) Ménière disease
D) Orthostatic hypotension
E) Perilymphatic fistula
F) Postconcussive syndrome

Correct Answer:

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