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Stroke Doc
Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 51
Experience:  I am board-certified in Neurology and the subspecialty Vascular Neurology.
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Doctor:Tuesday night I was taken to the hospital via EMS

Customer Question

Doctor: Tuesday night I was taken to the hospital via EMS due to a violent case of vertigo, nausea, and rapid heart rate. These attacks happened in waves and lasted around an hour or so. The ER gave me sugar water and saline then ran a bunch of tests. All my blood work and EKG came back normal. I was discharged after four hours in the ER.

 
It’s been two days and I still have a generally disoriented feeling along with very mild fatigue. I went to see my primary care physician and a neurologist who diagnosed me with Labyrinthitis. I am still concerned that it could be something more severe like Meniere’s. The doctor said because I have no hearing loss, or tinnitus that he could rule this out. I explained that I do not remember any ringing but wasn’t sure. He mentioned that if I had tinnitus, due to Meniere’s, I’d remember it. He said the ringing would be very pronounced. The attack came in waves and inbetween them I was able to seek advice from my mom (a nurse) on the phone, as well as talk to a professor (who escorted me to security), the security guards, EMS, and the ER staff. I remember hearing them fine and being responsive enough to answer their questions and talk with them. The doctor said this was evidence it was Labyrinthitis and not Meniere’s. He further checked my ears and said they looked perfect. 


My questions are: 1) Does his diagnosis of Labyrinthitis, and not Meneire’s seem correct? Given my great hearing now and not “remembering” any ringing or hearing problems. 2) I have to fly to California (from NYC) in a week-the doctor said because it is an inner ear problem that air travel will not be an issue. Does this seem correct? 3) He also told me my disorientation may last a few days, but will go away as quickly as it started and probably I'll never have another acute cause again. Is this correct? Again, I am more worried that this is something severe like Meniere’s (which would ruin my military deployment that is upcoming). A second opinion would be appreciated. Thank you so much!


PS: I should also note that last month I took a hearing test for the Army and it was perfect. Of course this was a month and a half before this took place. Also, the doc checked my eyes today and said they (like my ears) looked perfect. 

Submitted: 2 years ago.
Category: Neurology
Expert:  Stroke Doc replied 2 years ago.

To answer your questions:

 

1. It definitely does not sound like Meneire disease. While Meneire attacks are episodic, they aren't typically minutes apart, but rather days and weeks. Usually, hearing loss precedes the first attack of vertigo/dizziness. And tinnitus almost always accompanies it. It also tends to affect people in their 40's, though it can occur earlier. At this point, there's absolutely no reason to suspect Meneire disease.

 

2. The only safety issues with traveling will be the risks of flying itself. It will not cause anything unsafe medically related to your dizziness. The pressure changes that occur with flying could potentially exacerbate the dizziness/vertigo, but will not cause medical harm. (Note, being dizzy and off balance could cause harm if you fall; but flying itself won't cause medical harm in your situation.)

 

3. One can't predict whether you'll "never" have another acute attack of vertigo again; but in most cases, labarynthitis is a self-limited disorder: you have the attack, you get better, and most won't have recurrent attacks. (I assume by "disorientation" you are referring to dizziness/vertigo.) If it's labarynthitis, it typically subsides within a few days to a week or so.

 

All in all, Meneire disease is highly unlikely based on your description.

 

There's a lengthy list of things that can cause acute dizziness, but common things being common, the most likely cause if you took 1000 people your age with your symptoms would be labarynthitis. A few of the numerous things in the differential diagnosis would be eustachian tube dysfunction, benign paroxysmal positional vertigo (though most people with BPPV are over age 50), brainstem or cerebellar stroke (not very common in your age group), a cerebellopontine angle tumor (not common), a demyelinating (wearing away of nerve insulation) lesion such as multiple sclerosis, toxicity from various medications and/or illicit drugs, etc. With acute onset at your age (particularly if you can recall recently having even a mild upper respiratory tract infection, but that's not a requirement), labarynthitis is far and away the most common cause.

Customer: replied 2 years ago.
Dear sir:
Thank you so much for your answer. I would like to ask you just a few more questions.
1. My doctor advised against any type of motion sickness pills. Would earplugs be okay for the plane?
2. As soon as I am feeling better. Can I resume normal exercise? Like running? Of course, building myself up slowly.
3. Last night I started getting a strange feeling in my left ear. I cant really describe it, but it wasnt painful, just noticeable. Almost like a mild form of when you're in an airplane and you feel like your ear needs to "pop." When I woke up the next morning It felt as though there was an odd pulsation going on in my ears. However, the sound is not pronounced at all. I can only "hear" it if the room is ultra quiet. Once the tv, radio, or background noise is present...the feeling is drowned out. Sometimes I think I cannot even hear it anymore. Would this be tinnitus? or is tinnitus an actual ringing like a telephone? I might just be amplifying normal sound because it's been on my mind. This is definitely not like a ringing sound and I can forget about it when not thinking about it. This is all coming about about two and a half days after my attack..Would hearing symptoms occur after the attack or mostly like you said, preceding and during one? Also, despite the ears (whether tinnitus or my amplification of ambient noise) I felt a lot better today. Not 100% but much better. I know my doctor said labyrinthitis often accompanies an upper respiratory or ear infection, and my sinuses have been acting up, but not sure if sinus would cause the ear trouble.
Expert:  Stroke Doc replied 2 years ago.

1. Wearing earplugs should not cause any problems.

 

2. Assuming this is labarynthitis (As I cannot evaluate you personally, I can only speak in the hypethetical sense.), when the dizziness/nausea resolve, resuming exercise (starting as tolerated) is fine, taking precautions to avoid falls.

 

3. What you are describing is not tinnitus. Tinnitus is a ringing--less like a telephone and more like cicadas (those noisy insects that appear every few years). The "pulsation" you describe could be a benign spasm of the muscles (very tiny) of the inner ear related to inflammation; or it could be from pressure changes associated with eustachian tube (a canal between your inner ear and the back of your throat) inflammation. It definitely is not tinnitus. Hearing loss (and it's pretty frank hearing loss--not alteration in what you hear or amplification of hearing) usually occurs prior to onset of dizziness, but less commonly can occur after. Meneire disease is not that common; and your case doesn't really sound like it at all.

 

I'm glad you're starting to feel better. I feel quite confident that this is not Meneire disease; but only time can really tell.

Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 51
Experience: I am board-certified in Neurology and the subspecialty Vascular Neurology.
Stroke Doc and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
Thank you sir for the detailed and thoughtful responses. I really appreciate the second opinion you have given me. If the ear pressure does not subside I will inquire about the possibility of it being related to an underlying ear infection and seek treatment. Thank you again!
Expert:  Stroke Doc replied 2 years ago.
Glad to help. Thanks.

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Stroke Doc
Stroke Doc
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I am board-certified in Neurology and the subspecialty Vascular Neurology.