A 45-year-old woman presented to the emergency department with complaints of sudden onset of vertigo, nausea, and vomiting that began earlier in the morning. She described the dizziness as a sensation of the room spinning, which worsened with head movements. She had difficulty standing or walking due to the severity of her symptoms. The patient also reported having a mild cold with nasal congestion and a sore throat for the past 3 days.

The patient denied any history of hearing loss, tinnitus, or prior ear infections. She had no history of head trauma or recent changes in her medication regimen. She did not report any neurological symptoms such as weakness, numbness, or vision changes.

Upon examination, the patient appeared uncomfortable due to the dizziness but was otherwise alert and oriented. There was no fever or nystagmus observed at rest. However, when asked to perform a head-impulse test, she exhibited difficulty maintaining balance, and a slight horizontal nystagmus was noted on head movements. Neurological examination was otherwise normal.

The patient was diagnosed with Labyrinthitis, likely a viral etiology, given the preceding viral upper respiratory tract symptoms.

• Symptomatic treatment with antiemetics (ondansetron) and meclizine for vertigo.

• Encourage hydration and rest.

• Follow-up with an otolaryngologist if symptoms persist beyond 2-3 weeks.

• Consider a short course of corticosteroids if symptoms do not improve.

This case illustrates labyrinthitis, an inner ear infection that can cause vertigo, nausea, and imbalance, often following a viral infection.