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Altered consciousness, pressure in ear after SSHL. Reason?

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I have pressure (tightness feeling) in my right ear. This came about 2 weeks after I recovered from SSHL (Idiopathic), but came right after I had a cold and was on a plane. Now I feel lightheaded 24/7, and the tinnitus is constant. I have no hearing loss (anymore)(I have uploaded 2 files), originally I did (about 5 months ago). my hearing is now perfect, MRI is good. ENG and Ecog were good. What is going on?!?!?, I do not have any vertigo or dizziness - In the spinning traditional sense. I have been to over 4 ENT's with no conclusion of anything. All they do is refer me to a dentist for TMJ (I have not went yet). I am 24 years old patientold. They cannot locate the problem - But I feel so horrible. I'm in constant 24/7 brain fog and altered consciousness and extreme lightheartedness. I cannot begin to explain how horrible this feels.

I feel very anxious and nervous. But I cannot be blamed for this, nor should this be a factor for my "real" physiological problems.

A few other bothersome symptoms :
Note: Symptoms 1-6 started to occure ~2 weeks AFTER my hearing came back from SSHL. 

1. I have mild (often sharp) ear pain (in the affected ear)
2. I had base-line tinnitus my whole life, it was very mild. Now it is being weird - It's frequency is mostly high, but tunes down a bit, then back up. I often hear a 5 second high pitched sound that fades. (This recently started happening in my left ear as well -But only the fading tinnitus)
3.My eyes (mostly right) is always bloodshot red.
4. my effected ear constantly pops / clicks when I do a certain neck moment (left to right) or when I yawn.
5. Yawning increases the tinitus in my affected ear at least by 2 fold.
6. It feels like something is physically stuck in my ear!!
7. My legs feel very weak and heavy constantly


I would really appreciate any advice you can give me.
I don't know what else to do. This is severely affecting my everyday life. It has been going on for 5 months already.

Best.

Category: ENT Specialist

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Category: ENT Specialist
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Hello,

Thanks for posting your query at DoctorSpring.com

I can understand your problem.

You are suffering from fullness and tightness in ear with tinnitus. You had SSNHL which improved, You are not suffering from any hearing loss and giddiness. Your audiogram shows normal hearing and MRI, ENG and ECoG normal.
Most likely you are suffering from eustachian tube dysfunction (tube connecting ear and nose). That’s why your symptoms changing with air travel and cold.

You can start following medication-
Tab. Levocetrizine 5 mg/ desloratadine (Claritin) one daily for 20 days.
You can start tab. Bilovas (ginkoba bilovas) 120 mg once daily for one month for tinnitus.

Hope this helps, feel free to ask further queries.
Best regards


Patient replied :

Dear Dr Sunil Jalan,
Thank you very much for taking your time to address my cocnern.
I really do appreciate your professional Suggestion.
I would like to Clarify the Following with you:
1. What are the chances that this actually can be TMJ ? (Following SSNHL) ? Is it possible that TMJ was the primary reason for my Hearing loss to begin with ? 2. Is eustachian tube dysfunction correlated with SSNHL ? If not, is this just a coincidence ?
3. I have looked into some really nasty things and have greatly built up my worries and anxiety after I found things like Meniere's disease, or any version of Endolymphatic hydrops. In your professional opinion, can this be ruled out ? Considering the Tests I have done. The one thing That still keeps me sane is that I read the symptoms from Meniere's disease come at once very swiftly (the pressure in ear, tinnitus, followed by fluctuating hearing loss and then sudden vertigo) - In other words, the attacks come in clusters - I don't have this. As my symptoms are 24/7, constant and do not include fluctuating hearing loss (or any hearing loss), and I have no virtigo. As far as the "giddiness" that you have mentioned - Besides the lightheadedness, I do not feel severe "giddiness". I really want to know if this horrific disease can be excluded? I know it is probably impposible for you to professionally answer me via the internet, maybe I can just have your opinion for this question ?
Doctor, thank you very much for your valuable time.
Best regards.


Hello,

Thanks for your follow up.

I can understand your problem

1.TMJ is temepromandibular joint dysfunction is pain in front of ear in joint, you did not mention anything like this so we can exclude it.
2.Eustachian tube dysfunction is not correlated with SSNHL, it may be a coincidence or may be an error in audiogram that point of time as hearing loss in Eustachian tube dysfunction is conductive not sensorineural but it can improve with time.
3.Meneire’s diseass is a triad of vertigo, hearing loss and tinnitus. You do not have any hearing loss and vertigo so we can safely exclude meneire’s disease and we do not require any further investigation.
4.Most likely you are suffering from eustachean tube dysfunction (tube connecting ear and nose). That’s why your symptoms changing with air travel and cold.
You can start following medication-
Tab. Levocetrizine 5 mg/ desloratadine (Claritin) one daily for 20 days.
You can start tab. Bilovas (ginkoba bilovas) 120 mg once daily for one month for tinnitus.
Hope this helps, fell free to ask further queries.

Best regards

Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)


Patient replied :

Dear Dr Sunil Jalan,
Obstruction or blockage of the eustachian tube results in a vacuum in the middle ear (negative middle ear pressure), with resultant retraction (sucking in) of the eardrum.
My middle ear pressure is normal, and my eardrum is not retracted. All the ENT's I have went to do not think this is the cause.
Would you have another suggestion? It clearly has somethign to do with SSHL....I clearly did suffer form this. There was no mistake on my Audiogram. (Even if it is perfect now) - there WAS a problem.
I would like to ask you, from your experience - Have many patients with SSHL fully got rid of the ear pressure problem ?
This is my most bothersome symptom. And I am tremendously worried it is not due to an increased pressure in the endolymphatic sac. Can you please comment on this?
Thank you for all your help. I really appreciate it even If I tend ot disagree with it. I do not want to be misdiagnosed with my chronic ear pressure/pain problem.
Best regards.


Hello.

SSNHL is many a times idiopathic (when we do not know the cause) as in your cause. It may not be related to any eustachian tube dysfunction, if present.

In your case this may be a possibility as all investigations are normal including MRI brain, ENG, EcoG. Your repeat audiogram is normal (normal hearing). Mild cases may not show the typical retratcted ear drum or the pressure changes.

Symptoms of increased pressure of endolymphatic sac are giddiness and hearing loss. At the same time, ENG and EcoG will also show abnormal reports. Also, we can see dilated endolymphatic sac in the MRI. Repeat audiogram should also show hearing loss.
Since all of this is absent in your case, the possibility of endolymphatic disorder is very unlikely.

And with all your investigations being normal, I can assure you that we are not missing any serious condition.

I also have some limitation because of this being an online consult and because I cannot examine you directly. If your local doctor advises, you can start symptomatic treatment for your symptoms.

Hope this was helpful. Feel free to ask further queries.
Best regards


Dr. Sunil Jalan
Category: ENT Specialist
Experience: 
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
Dr. Sunil Jalan and 4 other Medical Specialists are ready to help you

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