Social media remedy gone wrong: posterior canal BPPV following nasal saline rinse in a patient with Patulous Eustachian tube - a case report.

Introduction and importance: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, typically due to dislodged otoconia within the semicircular canals. Patulous Eustachian tube (PET) is an uncommon condition characterized by an abnormally open Eustachian tube, which may alter middle ear pressure and potentially affect vestibular function. Presentation of case: We report a 36-year-old female with known PET who developed sudden-onset vertigo after using a hypertonic saline rinse recommended on social media. She instilled the solution into her ear canal, which immediately led to ear blockage and positional vertigo. Examination revealed left posterior canal BPPV due to suspected cupulolithiasis. She was successfully treated with Semont and Epley maneuvers, with complete resolution of symptoms on follow-up. Clinical discussion: This case highlights a rare instance of posterior canal BPPV triggered by a self-administered remedy for PET. The likely mechanism was a rapid inner ear pressure change, dislodging otoconia into the semicircular canal. Conclusion: Clinicians should counsel PET patients about evidence-based treatments and warn against unverified social media remedies, which may cause avoidable complications like BPPV. They must counsel PET patients on safe, evidence-based treatments and the dangers of self-treatment found online.