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Disequilibrium, unwell, tiredness, headache, pain, vertigo, numbness. What do you think this is?

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ENT Specialist
Practicing since : 1991
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For nearly 5 months I have had disequilibrium, General feeling of being unwell, tiredness,Headaches and sharp pains in head, occasional vertigo, numbness in my right cheek and eye (My face looks ok) occasional numbness and tingling in right hand, and nausea. I was diagnosed with Labrinthitus and have been referred to an ENT doctor. Please could you advise what you think this may be as I do not feel it is an inner ear problem and am worried it may be something like a brain tumour.
Posted Mon, 23 Apr 2012 in Brain and Spine
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. Labyrinthitis involves both the hearing organ (cochlea) and the balance system (labyrinth). This means that for a diagnosis of Labyrinthitis, you need to document both hearing loss and dizziness. This differentiates Labyrinthitis from Vestibular Neuritis.

2. Get a PTA (Pure Tone Audiogram) and a Impedance Audiogram (I/A) done.

3. SInce you have many other symptoms [such as disequilibrium, general feeling of being unwell, tiredness, headaches, sharp pains in head, occasional vertigo, numbness in your right cheek and eye (Trigeminal or Fifth Cranial Nerve) occasional numbness and tingling in right hand, and nausea] , you must get an MRI Brain done to rule out any intracranial pathology.

4. A negative MRI will rule out any brain tumor conclusively.

5. Migraine and migraine associated vertigo or disequilibrium will require a Neurologists' opinion and you may also be advised an EEG (Electro-Encephalo-Gram).

6. Thare are many causes besides brain tumors which can lead to such symptoms: Anemia (Low Hemoglobin), Blood pressure problems, low Vit B12, abnormal calcium levels, Hypothyroidism, Prolonged use of Oral Contraceptive Pills and so on. A Stroke is very unlikely at your age.

7. If your disequilibrium lasts all day or occurs while walking, it may be central (brain related) in origin. True ear vertigo is a spinning sensation. Ear related vertigo usually occurs in short bursts and with change of head position such as lying down or sitting up. Can you describe your dizziness in detail?

8. You may follow up with your examination and investigation reports here for further treatment options.

I must emphasize that brain tumors are extremely rare. Many are benign and troublesome only because they are confined in a restricted space in the skull.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.


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Follow-up: Disequilibrium, unwell, tiredness, headache, pain, vertigo, numbness. What do you think this is? 41 minutes later
I had a blood test 3 months ago and was checked for liver, kidney, thyroid, complete blood count etc which all came back clear.
My dizziness is quite a constant feeling of being unbalanced with occasional room spinning sensations which last for a few seconds. Being in supermarkets, malls etc and Reading and computers can all make me feel worse.
I also get tinnatus which is mostly when I'm led down and occasionly my neck is very painful at the base of my skull. Most times when a dr has checked my ears or ear have had a lot of fluid.
My blood pressure has been slightly higher the past few months ranging from 120/80 to 140/90ish. I'm not sure if this is just because I'm very anxious about how I'm feeling or if there is a problem?
Answered by Dr. Sumit Bhatti 9 hours later

Thank you for writing back.

1. Given the symptoms that you have described, the following diseases may be responsible for these:
a. Cervical Spondylosis
b. Phobic Postural Vertigo
c. Vision or eyesight disorder
I would suggest that you consult a neurologist and an ophthalmologist who can examine you thoroughly and rule out the above conditions.

2. Please get the audiometry tests done. They will confirm the presence or absence of hearing loss or fluid in your ears.

3. Your blood pressure range is within the normal range. You don’t need to worry about this aspect.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Disequilibrium, unwell, tiredness, headache, pain, vertigo, numbness. What do you think this is? 6 days later
I have seen the consultant yesterday who did a hearing test and pressure test of my ears which was all fine. The consultant has ordered an MRI scan and a balance test where they put warm and cold water in your ears?
The consultant was not very good at answering my questions and didn't really explain anything so I have come away more worried than I was before! Please can you explain these tests and what will happen. Please can you also let me know if I would have to have contrast XXXXXXX as I really would not want to have this. Is it likely to be a scan without contrast? Can you refuse the contrast? How long does a head scan normally take and what will they be looking for?
Also I had to march on the spot with my eyes closed which I found really hard and he said this wasn't normal.
Please could you explain what it means if I can't do this? Also because the tests I had done were clear does this mean that it is not a inner ear problem? What will happen following the next tests?
In response to your previous answer I had my eyes tested about a month ago, I needed a very small prescription but mostly because they said the muscle in my left eye was weaker than my right so this can cause headaches? Everything else was fine.
Sorry for all the questions I am just so worried and really feel that my appointment was rushed at the end of the day and no questions of mine were answered. I hope you can be of some help to me and I look forward to your response.
Answered by Dr. Sumit Bhatti 5 hours later

Thank you for following up.

1. It is good to hear that your hearing test and tympanometry tests are normal. This either means that you did not have labyrinthitis or that you had complete recovery after a labyrinthitis.

2. A Bithermal Caloric or Fitzgerald Hallpike test involves instilling warm (44°C) and cold water (30°C) at 7 degrees centigrade (°C) above and below normal body temperature (37°C) in the external ear canal. The patient lies supine with head elevated at 30° to the horizontal and the gaze is usually fixed on to a point on the ceiling. Sometimes a special type of goggles (Frenzel's) are used. Normal people get nystagmus (involuntary eye movements) within a minute and this lasts for a minute or two. The fast direction of this nystagmus is seen as per the mnemonic COWS: Cold Opposite, Warm Same. Hence patients are classified as per the type and duration of the response as Normal, Canal Paresis or Canal Preponderance. These results indicate a healthy system or weakness of one or both sides, equal or unequal. This test basically measures the health of the vestibular system (Labyrinth including semicircular canals). This test is a part of the ENG (Electro Nystagmo Graph) test.

3. An MRI on an average takes 30 to 45 minutes. You may insist on and refuse contrast in your consent form. Contrast injection may be an option if something abnormal is seen in the initial scan. The injected XXXXXXX increases the contrast ratio and enhances tissue differentiation, thereby increasing the accuracy of the MRI diagnosis. If your initial MRI is normal, there is no need to take a contrast injection. Here the only risk is failure to detect miniscule lesions only.

4. The Unterberger's stepping test involves marching on the spot with eyes closed. Patients usually rotate slowly to the side of the labyrinthine lesion. However this is only one of the many tests. It does not have much significance alone.

5. Any weakness in vision will cause strain and headaches. Get your vision corrected with prescription glasses.

It is beyond the scope of this answer to explain each and every balance test. Each test for balance which turns out normal decreases the chance of a severe balance problem. Our brain has a tremendous capacity to re-adjust the balance system. This usually occurs in six to eight weeks after an acute balance problem. Hence the results of the tests vary in the same patient depending on the timeline.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

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