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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35768
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a chiari malformation, syringomelia with shunt in

Customer Question

I have a chiari malformation, syringomelia with shunt in place. I have been dizzy for the last 5 years and cannot lay down or turn my head. Ent says brain, Neuro says inner ear. What now?
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.

Hello and welcome,

I am very sorry for your prolonged undiagnosed issue.

What are the investigations done to differentiate between a neurological and inner ear issue?

Customer: replied 2 years ago.
I have had annual mris since decompression and shunt placement. No change in tonsillar herniation or sign of shunt malfunction. Have had caloric/water and air testing at Ent. Hearing loss but ENT says nerve damage from chiari and tinnitus from Chiari as well (have had tinnitus for as long as I can remember). I take small doses of diazepam (1-2 mg) and meclizine when vertigo is bad. I have balance issues and gait issues as well. Once again no one can differentiate from inner ear disorder and damage to the cerebellum as the cause.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Thanks for the further information.
Following are the investigations which are likely to clinch the diagnosis;
1) audiometry,
2) vestibular tests.
The most commonly performed vestibular tests are as follows (many of which may have been done for you; they need to be repeated as initial screening may be normal):
Electronystagmography (ENG)The rotating-chair test, also referred to as sinusoidal harmonic acceleration (SHA), Computerized dynamic posturography (CDP).
3) blood tests for autoimmune disorders,
4) computed tomography (CT), and magnetic resonance imaging (MRI).
5) The saccadic test
6) The gaze test
7) Pursuit eye movements test
8) Optokinetic Nystagmus test
9) Head shake nystagmus test.
10) Positional nystagmus testing
11) Bithermal calorie test.
12) Rotating chair test.
13) An alternative to the rotating-chair test is the active head-rotation test,
14) Computerized dynamic posturography
The causes for dizziness and vertigo can be be complex and sometimes multiple issues are responsible. So one may need to see all these concomitant illnesses. Going to a hospital attached to a medical school is best as specialist there work under same roof, are academic and research oriented and work in tandem.
An ENT specialist and a neurologist with a Rehab specialist are involved in the investigative work up and care.
Falls / imbalance / vertigo can be decreased or prevented an exercise program, till you are investigated.
Exercises are graded in difficulty based on velocity of head and object motion and by progression of body positioning from sitting to standing to walking. The exercises are graded in difficulty by narrowing the base of support, making the surface uneven, or changing the surface from firm to soft. Varied walking exercises are graded in difficulty by changing direction, requiring performance with the eyes closed, increasing speed of ambulation, walking on soft surfaces, or navigating stairs. An aerobic exercise home program progressively increasing the time, speed, or distance that the one could tolerate also can be initiated. But all of these may need supervision of a doctor if vertigo / dizziness is severe.
Following are the concomitant common causes in your age group with your other diagnosed issues;
1) Acoustic neuroma
2) Vestibular neuronitis
3) Inner diseases; mainly these are autoimmune disorders and may have other issues associated like arthritis.
4) Benign Paroxysmal positional vertigo.
5) Migraine
6) Meniere disease.
7) Neuropathy
8) Orthopedic disorders
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Wishing you all the very best in life.