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Ringing ear, vertigo and difficulty concentrating. Diagnosed with meniere's disease. Which specialist should I consult?

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Terrible ringing in right ear, vertigo and difficulty concentrating ... have restricted sodium intake to 1,300 mg per day for 2 weeks no improvement. Pain down left side of neck sometimes. Famly Doctor diagnosed Meniere's Disease but I've had no vomiting or nauseau. I've been taking Daily vitamins and Lipoflavinoids. Been taking 100 mg. Zoloft for 20 years. Should I go see a Neck Doctor or an ENT?? Scared and tired of not feeling right. Felt this way since end of November, 2012.
Posted Thu, 14 Feb 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 36 minutes later

Thank you for your query.

1. 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. Pain in the neck is not a known symptom. This condition develops suddenly or slowly and erratically and varies from person to person. You need to see an ENT Specialist, an Orthopedic and a Neurologist.

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 (ETD). If this Impedance Audiogram is normal, it may be Meniere's as it does not affect the middle ear.

4. 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. MRI Scans display anatomy and form, not function. 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.

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

6. What is your exposure to occupational noise and loud music / earphones / mobile phones? Exposure to loud noise is also a leading cause for tinnitus. How severe is your tinnitus on a scale of 1 to 10? Do you have nystagmus (abnormal eye movements)? Is the tinnitus pulsatile (matching with the heartbeat)? Does you have any other co-existing conditions including anemia (low hemoglobin), thyroid problems, blood pressure fluctuations, cervical spondylosis, nasal problems besides ETD or history of head injury? Has BPPV (Benign Paroxysmal Positional Vetigo) been ruled out?

7. If steroids have not controlled your Tinnitus and your middle ear is normal (no eustachian dysfunction), then you may try Caroverine (Tinnex) injectable or capsules. Use of hearing aids may help mask tinnitus.

8. I must emphasize that there is no cause for worry. The scared feeling, loss of confidence and not feeling right are very common during attacks of dizziness. However, the body adapts within a few weeks and the balance always improves.

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

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