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Have tinnitus in left ear and get panic attack. Could this be due to mild stroke or brain / neurological damage?

Answered by
Dr. Anjana Rao Kavoor


Practicing since :2008

Answered : 1197 Questions

Posted on Mon, 18 Nov 2013 in Brain and Spine
Question: Hi

I have had tinnitus in my left ear for about the past 9 months.

Last October I was participating in a Judo class when I got caught in a choke which compressed one side of my neck - i was stuck in the choke for a while trying to escape when i felt faint and thought i might pass out. i managed to alert my partner by tapping him (when i did this it was hard to lift up my hand). After a few seconds the blood returned to my head and I felt fine. I felt fine for about the next hour when i began to feel strange. Now looking back i think i may have been having a panic attack. i felt light headed like i might pass out. I got a taxi home and went to the hospital.

at hospital a nurse took an ecg of my heart and said that this appeared normal. i then decided to go home and called a doctor who came the next morning. i still had a slight headache and he told me to take two neurofen and get some sleep. he felt that i was very anxious and that i was fine.

the next day or the day after that i developed tinnitus. i was also suffering headaches and i had also strained a muscle in my neck and this was causing severe paid in the back of my head and adding to my anxiety which in turn increased the headaches. i think the headaches were mostly tension headaches as a result of anxiety.

i got an mri of my brain which turned up normal.
at this stage the tinnitus was a continuous tone and was high pitched. after i got the mri my doctor told me to forget about it and i did. i went back exercising and after about two weeks the tinnitus disappeared. about 2 weeks later however it came back (start of December) and i have had it since.

now much of the time during the day i do not hear it and it seems to be very slowly improving somewhat over time - sometimes i do hear it during the day and it is a high pitched tone which comes in and out like a car braking

at night however there are various shifting tones in my left ear only - i always hear it at night - sometimes when i wake up in the middle of the night or early in the morning it is gone but then it comes back after a few minutes

the tinnitus does change alot and is not always the same tone or pitch

i have had a brain mri which was normal, an mri of my cervical spine which was normal and also a cartoid doppler which was normal

my hearing test is also normal

do you think i could have suffered mild stroke or brain / neurological damage which is the reason for my tinnitus

now i have good fitness and strength - i have no complications other than the tinnitus (i work as a lawyer) i do notice crackling in my ears and pressure in my ears sometimes and sometimes a very slight pain on the left side of my neck - therefore i think the tinntus could also be related to sinus problems / eustation tube problems and / or muscle related

i would be interested to hear your view on whether you think it could be neurological or as a result of some brain damage / minor stroke - and whether there is any possibility for repair or whether you have any recommendations - i should say that once before in judo a few months before this i did pass out for a few seconds (no more than 5 or so) when i got caught in a choke that compressed both arteries n my neck - i no longer practise judo

kind regards
Answered by Dr. Anjana Rao Kavoor 3 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Thanks for writing in to us.

I have read through your query in detail.

If your MRI brain is normal, there has been no stroke or stroke like situation in your brain, please be assured about that.

Carotid Doppler being normal signifies that there is no structural obstruction of change in hemodynamics to the blood supply to brain. In other words the carotids and vertebral artery blood flow is normal.

The possibility of neck injury is also ruled out by normal cervical spine MRI scan.

There is some information on sinusitis and tinnitus:
The sinus cavity (which is positioned between both ears) functions as a dirt catcher to prevent foreign objects from entering the lungs. If it gets irritated because of the dirt that it catches, it will result in swelling and exert the pressure to the ear drums. This pressure can make the ear drum react through ear ringing (tinnitus).

But why does pressure start to build? The pressure is created because of the pressing of the swollen sinus cavity. Pressure can also increase as you start to blow your nose to get rid of the mucous. That very act will heighten the pressure further and can even lead to pain in your ears.

That’s not the only reason why sinuses cause ringing ears. When a person is suffering from sinusitis, his nasal pathway is blocked. When the nasal pathway is blocked the ear canal also gets blocked and causes the disruption of the flow of sound into the ears. This makes the ear concentrate on the XXXXXXX noise, which creates a ringing sound. Sometimes you may even hear the blood flowing with your heart beat.

Sinus ear ringing is a very painful and tedious condition – in addition to having difficulty breathing, you also need to deal with the ringing in your ears. So what can you do if you have both sinus problems and tinnitus?

Since it is the sinusitis that causes the ear ringing, the ringing will stop if the pressure is lowered. This can be achieved by using nasal sprays, decongestants and antihistamines. These sprays will reduce the inflammation of the sinus but you need to make sure you choose the right antihistamine. Some antihistamines aggravate tinnitus so while you may have decreased the pressure, the ringing may actually get worse.

The choking might be due to temporary compression of carotid arteries and that can cause temporary black outs.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Anjana Rao Kavoor 12 days later
Hi Doctor thanks for your reply

Given that the tinnitus has been present for 9 months continuously - do you think it could be related to sinus problems / eustation tube problems?

I have had a few sinus infections over that time but then again I have had periods when there was no sinus infection - and the tinnitus has been present at both times.

also given that the tinnitus is in one ear only - is it still possible that it is sinus issues?

is there any particular antihistamine you would recommend? I did try fluxonaise for a few months (two sprays in each nostril daily) but it did not make much of a difference - is it possible that if I tried this with 4 sprays in each nostril daily that this could make a difference?


Answered by Dr. Anjana Rao Kavoor 17 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
You are welcome and thanks for writing in with an update.

The paranasal air sinuses are paired structures and can get infected only on one particular side causing sinusitis. In sinuses, there is filling in of secretion in the sinus cavity with blockage to outflow. Subsequently this gets infected causing sinusitis. At the same time there is pressure difference along the Eustachian tube and this causes tinnitus. Therefore tinnitus with underlying sinus pathology can present be seen involving only one side.

Research on tinnitus done in 2004 and published in Journal of the American Academy of Audiology says the following:

With severe tinnitus in adults, coexisting factors may include hearing loss, dizziness, head injury, sinus and middle-ear infections, or mastoiditis (infection of the spaces within the mastoid bone).

Flixonase or Flonase (fluticasone) is a nasal spray containing steroid. I suggest you limit your dosage to two sprays in each nostril daily. You may take one spray in the morning and once in the evening. I can suggest you Fexofenadine (trade names Allegra, Fexidine, Telfast, Fastofen, Tilfur, Vifas, Telfexo, Allerfexo)is an antihistamine pharmaceutical drug used in the treatment of sinusitis. Please discuss the medication dosage with your doctor and take it under your doctors guidance.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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