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Having Nausea, Weakness And Ear Infection. CT Scan And Blood Test Done. Required Treatment?
Question: Hi, I have several symptoms and no clear diagnostic.
My simptoms are: a feeling of wheight in on one side of a body, especially the head, the feeling like falling on that side and the tendency to step in that direction while walking, a feeling of pressure on that side of the forehead, a feeling of pressure and instability at the back of the head, emptyness in the stomach or slight nausea, weakness, pressure in that nostril, sometimes slight unclear vision.
I also have a slight sensation that something is in my ear, a slight sensation of heat in the ear, and moments of ichiness or pain, but very rare
On that side, I had a ear infection that was treated with antibiotics.
I treated again these symtoms with augmentin, they where gone, but after 2 weeks where back.
I took ZInat (cefuroxim) at doctors recommandation, suspecting an infection
I did several tests
CT: brain ok, ear having no fluids, medium hipertrophy of nasal cornets.
Blood: everything ok, no bleeding, calcium, magnesium normal, slight deficiency of iron, that was at the lowes level.
Posturography: very good.
Doppler for blood vessels in the region of the head, like carothidis: nothing wrong
Gynecological consult: nothing wrong
The ORL specialists say that the ear sometimes get blocked because of the nose problem.
Now I had a virus, with caughing an nose blocking, it passed away, but I have the same symptoms.
I just cannot walk straight, cannot perform my day to day job, and I dont know what to do, because I already took a lot of antibiotics.
WHat could be the cause? And what is a possible treatment? Is it an ear problem?
Please help me because I XXXXXXX t know what to do, I need some guidance to get the diagnostic
I am female, 29, software programmer, I work very much at the computer
My simptoms are: a feeling of wheight in on one side of a body, especially the head, the feeling like falling on that side and the tendency to step in that direction while walking, a feeling of pressure on that side of the forehead, a feeling of pressure and instability at the back of the head, emptyness in the stomach or slight nausea, weakness, pressure in that nostril, sometimes slight unclear vision.
I also have a slight sensation that something is in my ear, a slight sensation of heat in the ear, and moments of ichiness or pain, but very rare
On that side, I had a ear infection that was treated with antibiotics.
I treated again these symtoms with augmentin, they where gone, but after 2 weeks where back.
I took ZInat (cefuroxim) at doctors recommandation, suspecting an infection
I did several tests
CT: brain ok, ear having no fluids, medium hipertrophy of nasal cornets.
Blood: everything ok, no bleeding, calcium, magnesium normal, slight deficiency of iron, that was at the lowes level.
Posturography: very good.
Doppler for blood vessels in the region of the head, like carothidis: nothing wrong
Gynecological consult: nothing wrong
The ORL specialists say that the ear sometimes get blocked because of the nose problem.
Now I had a virus, with caughing an nose blocking, it passed away, but I have the same symptoms.
I just cannot walk straight, cannot perform my day to day job, and I dont know what to do, because I already took a lot of antibiotics.
WHat could be the cause? And what is a possible treatment? Is it an ear problem?
Please help me because I XXXXXXX t know what to do, I need some guidance to get the diagnostic
I am female, 29, software programmer, I work very much at the computer
Hi,
Thank you for your query.
1. I am assuming that the middle ear pressures and fluid was excluded by a Tympanogram (Impedance Audiometry). If not, you may get this test done. I would also like to know your PTA (Pure Tone Audiogram) report.
2. Dizzines due to acute ear problems is usually a spinning sensation (vertigo). You seem to have an imbalance and not rotatory vertigo.
3. One ear problem which would give a feeling of ear fullness or blockage, diziness, empty feeling in the stomach is Meniere's Disease. 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.
4. Tests for certain abnormal eye movements (Nystagmus) and other tests (Head Impulse Test, Head angulation, Skew Deviation, Gait testing and so on) can only be performed by direct observation. Hence you should consult a Neurotologist.
5. Sinusitis and Migraine associated vertigo must be ruled out. It is odd that you have a tendency to step in a certain direction (you have not mentioned the exact side) and yet the Posturography is normal. This would mean only a slight imbalance. Ear related vertigo usually does not occur on walking. It occurs when the head is moved against gravity.
6. By unclear vision, do you mean an up and down bobbing movement of the visual field (oscillopsia) or blurring / double vision (diplopia)?
7. If you can upload the results of the above mentioned tests, further treatment options may be discussed.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Thank you for your query.
1. I am assuming that the middle ear pressures and fluid was excluded by a Tympanogram (Impedance Audiometry). If not, you may get this test done. I would also like to know your PTA (Pure Tone Audiogram) report.
2. Dizzines due to acute ear problems is usually a spinning sensation (vertigo). You seem to have an imbalance and not rotatory vertigo.
3. One ear problem which would give a feeling of ear fullness or blockage, diziness, empty feeling in the stomach is Meniere's Disease. 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.
4. Tests for certain abnormal eye movements (Nystagmus) and other tests (Head Impulse Test, Head angulation, Skew Deviation, Gait testing and so on) can only be performed by direct observation. Hence you should consult a Neurotologist.
5. Sinusitis and Migraine associated vertigo must be ruled out. It is odd that you have a tendency to step in a certain direction (you have not mentioned the exact side) and yet the Posturography is normal. This would mean only a slight imbalance. Ear related vertigo usually does not occur on walking. It occurs when the head is moved against gravity.
6. By unclear vision, do you mean an up and down bobbing movement of the visual field (oscillopsia) or blurring / double vision (diplopia)?
7. If you can upload the results of the above mentioned tests, further treatment options may be discussed.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. I did audiogram, but not tympanogram. The audiogram was normal. I will do tympanogram and follow up with results.
2.True, I never had rotatory vertigo, just balance problems while walking. Also dizziness sensation that lasts only for 2 or 3 seconds, but it is not rotatory vertigo.
3.I dont have bad nausea, vommiting, or rotatory vertigo. Sometimes I do have tinitus and i feel ear bloating.
4. I did some tests like that. I did a head impulse test, a test when I had to walk straight with my eyes closed, I test for vestibular vertigo when I suudenly went from partialy standing position to horizontal with my head hanging outside the bed on one side. All that was ok. I didnt do any test related to my spine...I also have pain an a sensation of weight in my neck. When I rotate my neck it hurts and it makes a sound.
Is it possible to be a spine problem that causes instability?
5. Posturography was fine, but I XXXXXXX t experiment these symptoms all the time. For example I can walk for one minute, then feel inbalance, then again walk normal and so on. If you ask me to concentrate to stand still on a platform or in a certain position I dont have trouble.
6. Unclear vision means that I find hard to focus the image if I look at something more than 1 second for example. I see everything slightly dimly and I cannot focus. Maybe it is not related to the other symtoms.
2.True, I never had rotatory vertigo, just balance problems while walking. Also dizziness sensation that lasts only for 2 or 3 seconds, but it is not rotatory vertigo.
3.I dont have bad nausea, vommiting, or rotatory vertigo. Sometimes I do have tinitus and i feel ear bloating.
4. I did some tests like that. I did a head impulse test, a test when I had to walk straight with my eyes closed, I test for vestibular vertigo when I suudenly went from partialy standing position to horizontal with my head hanging outside the bed on one side. All that was ok. I didnt do any test related to my spine...I also have pain an a sensation of weight in my neck. When I rotate my neck it hurts and it makes a sound.
Is it possible to be a spine problem that causes instability?
5. Posturography was fine, but I XXXXXXX t experiment these symptoms all the time. For example I can walk for one minute, then feel inbalance, then again walk normal and so on. If you ask me to concentrate to stand still on a platform or in a certain position I dont have trouble.
6. Unclear vision means that I find hard to focus the image if I look at something more than 1 second for example. I see everything slightly dimly and I cannot focus. Maybe it is not related to the other symtoms.
Hi,
Thank you for writing back.
1. A normal Tympanogram (Impedance Audiometry) and a PTA (Pure Tone Audiogram) will help rule out most ear problems.
2. You have short bursts of imbalance, not true vertigo.
3. Early Meniere's Disease may have such symptoms. It takes years to develop or may burn out on it's own. Migraine associated vertigo must be ruled out.
4. Your postural tests were normal, hence BPPV (Benign Paroxysmal Positional Vertigo) is ruled out. This is the most common cause of ear related vertigo. The neck spasm is most likely due to the imbalance rather than a cause of it. Get Cervical Spine X-rays done to rule out any cervical spondylosis.
5. This seems to be a central problem such as vestibular paroxysmia which is usually treated with carbamazepine.
6. the unclear vision may be due to a momentary retinal image slip. Get an eye check up done.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Thank you for writing back.
1. A normal Tympanogram (Impedance Audiometry) and a PTA (Pure Tone Audiogram) will help rule out most ear problems.
2. You have short bursts of imbalance, not true vertigo.
3. Early Meniere's Disease may have such symptoms. It takes years to develop or may burn out on it's own. Migraine associated vertigo must be ruled out.
4. Your postural tests were normal, hence BPPV (Benign Paroxysmal Positional Vertigo) is ruled out. This is the most common cause of ear related vertigo. The neck spasm is most likely due to the imbalance rather than a cause of it. Get Cervical Spine X-rays done to rule out any cervical spondylosis.
5. This seems to be a central problem such as vestibular paroxysmia which is usually treated with carbamazepine.
6. the unclear vision may be due to a momentary retinal image slip. Get an eye check up done.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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