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Dr. Andrew Rynne

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What causes lightheadedness after having Prednisolone?

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Dr. Krunal Karade

ENT Specialist

Practicing since :2009

Answered : 1000 Questions

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Posted on Sat, 23 Aug 2014 in Ear, Nose and Throat Problems
Question: This question is for Dr Kunal:

Further to our recent consultation, I am following your recommended treatment. One quick question: for the last two days (Day 14 since onset of the sensorineural hearing loss and Day 8 since I started on oral steroids) I have started feeling light headedness. When I walk I feel like I am not totally balanced. As if I am having to do some extra effort to keep my orientation straight. Is this the impact of the prednisolone I am taking or does it signal the onset of Labyrithitis or Meniere's Disease? How do I distinguish between the two conditions?

doctor
Answered by Dr. Krunal Karade 1 hour later
Brief Answer:
It is less likely because of side effect of predni

Detailed Answer:
Hi ,
I have gone through your query .
It is less likely because of side effect of prednisolone . It is because of serc8 & kestine or continuation of initial disease .
I would advice you decrease the frequency of serc8 & kestine to twice daily .
In Labyrithitis there is severe vertigo , Nausea , vomiting & sensorineural hearing loss. Nystagmus to the opposite side .
In Meniere's Disease there is fullness in ear , lower frequency loss in audiometry , vertigo & tinnitus .
Hope this information helpful to you .If you have any further questions I will be happy to help.
Thanks.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Krunal Karade 3 hours later
Thank you doctor. Is it safe to presume that the sudden onset of brain fog, lightheadness and imbalance issue after no vertigo in the initial stage means there is an underlying vestibular disorder associated with my SNHL. As of now, my symptoms include unilateral hearing loss in left ear (since 16 days), fluctuating tinnitus (sometimes intense, sometimes less noticeable), blurred eyesight and imbalance/lightheadness (for last three days).

What is your proviosional diagnosis? Can an MRI indicate whether it is Labyrinthitis or Meniere's Disease? I sincerely hope its the former because I can probably live with one ear for the restof my life, but this balance issue is really worrying me.

doctor
Answered by Dr. Krunal Karade 52 minutes later
Brief Answer:
Provisional diagnosis is idiopathic sudden HL.

Detailed Answer:
Thanks for follow up query .

My provisional diagnosis in your case is idiopathic sudden hearing loss mostly viral . It is associated with unilateral hearing loss , tinnitus & temporary spell of vertigo .

In your case , lightheadness and imbalance is from 3 day only with no initial vertigo , mostly because of overuse of kestine & serc8 . It may be because of underlying vestibular disorder .

Yes , MRI can differenciate between Meniere 's disease & labyrinthitis . Discuss this with your treating doctor & get it done .
On audiometry , which you have done earlier Meniere's Disease will have low frequency hearing loss .

I can understand your concern , living with balance issue is really worrisome .
Hope you will be fine soon .
Wish you good health.
Regards.



Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Krunal Karade 15 minutes later
Thanks doctor. I will get the MRI done and also reduce Serc to 8mg two times a day.

My latest audiogram is attached. Does it look more like it is Meniere rather than Labyrinthitis

Since you suspect ISSNHL mainly from viral reason, shall I undergo a Herpes blood test to rule it out (I had an unexplained lesion on my lower lip 1 year back)? Do you think a course of Acycolivir could help in my case?

?
doctor
Answered by Dr. Krunal Karade 42 minutes later
Brief Answer:
I will suggest you reduce both kestine &serc8 both

Detailed Answer:
Thanks for follow up query .
I will suggest you reduce both kestine & serc8 both twice daily.

I have seen your audiogram , which show mixed hearing loss of left ear with notch at 2000hz . I would like to know whether your ENT specialist have done any Impedence audiometry with stapedial reflex , if not get it done . Also i like to know you have any family history of hearing loss at early age like you. Audiogram look like otosclerosis but clinical history present like ISSNHL .
Impedence audiometry with stapedial reflex & MRI will conform diagnosis.
Other test done in ISSNHL Random blood sugar , thyroid profile , lipid prolife , coagulation profile & VDRL .
I would not advice Herpes blood test for lesion 1 year back & Acycolivir because it is not routinely used in ISSNHL.
Most important is Impedence audiometry with stapedial reflex & MRI .
Hope above information helpful to you .
Thanks.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Krunal Karade 10 hours later
Thank you Doc. Based on your advice, I have cut down both Serc8 and Kestine to twice a day from today. The dizziness improved last night but is back again this morning.

As regards family history, my father started developed hearing loss in his late 40s / early 50s and is now in his 70s with profound hearing loss in both ears. Apart from that, there have been two incidents of children born to my parental uncles (married to their cousins) with deafness and dubmness issues.

My father is diabetic for around 40 years wnd had a mini-stroke 10 years back. I was myself suffering from Impaired Glucose Tolerance (fasting blood sugar levels were higher than 101) about 8 years back, then lost 35 kgs in 2010 and the problem completely disappeared, so far has not returned. My HbA1C which I repeat every 3-4 months consistently remains around 4.5% (normal range).

From what I understand from your note, you are ruling out Labyrinthitis and Meniere's Disease and are more inclined towards SSNHL prompted by Otosclerosis. Please confirm. Tha being the case, is my dizziness and balance disorder likely to improve once I start treating Otosclerosis? As you will appreciate, my concern has now shifted away from the loss of hearing in my left ear to managing the dizziness and ensuring a good quality of life. I can get hearing aids if needed but I need to feel well in order to work.

I will get the MRI and other tests done this week. Thanks for all your help.










t
doctor
Answered by Dr. Krunal Karade 37 minutes later
Brief Answer:
Diagnosis will conform after test.

Detailed Answer:
Hi,
Thanks for the query.
If you still feel dizziness , you can reduce Kestine once daily at night .
You have family history of hearing loss at early age & blood sugar under control .
My Differential diagnosis in your case
1) Otosclerosis
2) ISSNHL
3) Labyrinthitis
4) Meniere's Disease
Diagnosis will conform after test Impedence audiometry with stapedial reflex & MRI temporal bone .
You will need sodium fluoride tablet & antioxidant for Otosclerosis only after conformation of diagnosis .
I understand your concern , Quality of life is most important .
Show me report once test are done .
Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Krunal Karade 35 hours later
My MRI report has arrived. Shows all clear. Tympanogram is also attached - shows normal value. Meanwhile the dizziness and balance disorder have significantly subsided today and I was able to walk and move pretty much normally today.

What does the clear MRI exactly rule out? What's your differential diagnosis in view of the latest reports?
doctor
Answered by Dr. Krunal Karade 1 hour later
Brief Answer:
I am happy to here your dizziness subsides .

Detailed Answer:
Hi ,
Thanks for follow up query.

I am happy to here your dizziness subsides & MRI report is normal.

I am not able to see Tympanogram report here , only audiogram report seen. Does Tympanogram with stapedial reflex done & it is normal .

MRI rule out any infection ,endolymphatic sac distention seen in Meniere's disease ,any tumor & trauma.

Kindly post Tympanogram with stapedial reflex report.

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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