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Dr. Andrew Rynne

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Have mild vertigo, ear hurts and feels heavy. Any suggestions?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2569 Questions

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Posted on Mon, 26 Nov 2012 in Ear, Nose and Throat Problems
Question: I have mild vertigo and my left ear hurts and feels heavy and have had this for about 6 days....dont think it is the middle ear or ear infection as it clears fine with the valsalva manuerver....i think it's the inner ear....any suggestions? I have mild nystagmus too, but more a feeling like I am falling over, leaning, etc.

I been tested before with the Epley treatment in the past (2006), did nothing...also no hearing loss (no Menieres)....could it be diet related? or pressure changes in the atmosphere?....or labrinythitis occuring again? Meclizine does not help, Sudafed seems to help a bit.

I had severe vertigo in 2006 for 8+ months and it finally disappated. But I get these "attacks" from time to time and still have trouble laying flat after 7 years of the severe attack. Also, driving to high elevations ususally causes vertigo.

Any suggestions? Any natural alternatives? Medicines?

Thanks! XXXXXXX
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. If your dizziness is:
a. Not true rotatory vertigo (unsteadiness like being in a boat),
b. Constant or for hours and days together,
c. Not related to change in position like lying down or getting up,
d. Occurring even as you walk,
then it is less likely to be due to your ears.

2. You should get a PTA (Pure Tone Audiogram) to document any hearing loss. Meniere's disease usually causes low frequency hearing loss initially ( Audiogram sloping to left).

3. Get a Tympanogram done to check middle ear pressures and Eustachian Tube function. If this Impedance Audiogram is normal, it may be Meniere's as it does not affect the middle ear.

4. If this Impedance Audiogram is abnormal, then a trial of medication should be taken for three to four weeks. If this does not work, a myringotomy with a grommet insertion may help. Steroid drops can be given for a longer duration through this ventilation tube.

5. Do you have a history of any head injury, migraine, hyperacidity or recent cold? Sinusitis must be ruled out as Sudafed causes some improvement.

6. I will be able to guide you better about the possible cause if you can provide me more details of your dizziness like:
a. The exact moment when it all started,
b. How often and how long do the episodes last? Is it continuous?
c. Any other associated symptoms, such as nausea, vomiting or sweating?
d. I need to know if your hearing is normal. Does it fluctuate? Do you get any sounds (tinnitus) or fullness in the ear?
e. Is the dizziness true vertigo (spinning of the surrounding) or only unsteadiness.
f. Is the dizziness only when there is change of position (such as lie down or sit up)? Can you walk without support? Do you get dizzy when you turn in bed or look up while climbing stairs?
g. Is your vision clear or blurred? Is there any tendency to blackout?

7. It is also important to consult a neurologist to rule out neurological degenerations that can cause such symptoms. (MRI scans may not be enough to pick these conditions).

8. Meniere's disease is diagnosed on the following criteria:
a. Vertigo
b. Fluctuating hearing loss
c. Tinnitus
d. Fullness in the ear
There is usually nausea and vomiting, the hearing usually worsens during an attack and the tinnitus also worsens. Earache is not a usual symptom.

9. An MRI Scan is usually advised in a patient of vertigo so as not to miss any major cause, one of which is an Acoustic Neuroma. I must emphasize that Acoustic Neuromas are rare and almost 99% of MRIs are normal. Acoustic Neuromas also have other symptoms depending upon their size. They are benign and extremely slow growing.

10. MRI Scans display anatomy and form, not function. The Eustachian tube is normally in a collapsed state. It can be voluntarily opened by yawning, swallowing, chewing gum, blowing your nose or performing the Valsalva maneuver. A Tympanogram and eardrum examination is more important.

11. Meniere's disease should normally respond to a salt restricted diet, acetazolamide (diamox) and betahistine (Vertin).

12. If you do go in for an MRI, try a 3 Tesla Scan. It may pick up the subtle changes due to Meniere's Disease in the inner ear. Labyrinthitis includes the cochlea nad results in loss of hearing. Hence your diagnosis cannot be labyrinthitis if you have no documented hearing loss. Vestibular Neuritis affects only the balance system and not hearing. Hence Vestibular Neuritis was more likely.

13. From your description, it is not Meniere's Disease. Your vertigo is most likely to be due to the following:
a. BPPV (Benign Paroxysmal Positional Vertigo). However a tendency to black out or dizziness on the move is rare.
b. Orthostatic hypotension (Postural Hypotension) (tendency to blackout).
c. Anemia (Low Hemoglobin) (tendency to black out).
d. Motion Sickness (dizziness in a car/ high speed).
e. Altitude Sickness

14. You should get Cervical spine X-rays to rule out cervical spine spondylosis. An MRI Scan will help rule out any neurological condition. You have Occipital Neuralgia and hence these conditions along with Vertbro-Basilar insufficiency (vascular compromise) must be ruled out.

15. There are many tests such as VNG (VideoNystagmoGraphy), testing for nystagmus (abnormal eye movements during an attack of vertigo) and many features such as direction of and fatiguablity of nystagmus. These can only be observed in a patient.

16. Kindly let me know the results of your tests. This will help in suggesting further treatment. BPPV can especially be cured.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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