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HYPEACUSIS, TINNITUS, DIZZINESS and on ACETAZOLAMIDE. MENIERES?

Resolved Question:

hello.
if you can access my last q/a with you concerning dizziness you will have complete background on my hx. in brief: chronic dizziness ( daily, all day) since January 2014, nausea,false sense of motion, some visual effects of seeing things move back and forth (more like sliding), recently developed hyperacusis, tinnitus that changes pitch ( high pitched). no vertigo at all. sometimes when I lay down on my back with eyes closed I get a few seconds of feeling like I am spinning. goes away when I open my eyes. two differ docs think a different cause. one thinks scds ( although ct scan doesn't definitely show one. one doc thinks menieres. he put me on acetazolamide 125mg bid. if this makes me feel better, does it mean I have menieres? and if I don't have it will it harm my vestibular system in any way?
thanks
steve

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Patient replied :

hello. my last vemp test the other day showed a 25% reduced asymmetry on the right. two prior ones from the past few months showed: in March a 53% reduced asymmetry on the right. in July it showed a 41% reduced asymmetry on the right. does this mean anything to you? visited ent two days ago. i passed the weber test. the sound didn't lateralize. heard it in both ears the same. i have no autophony or visual disturbances. balance is fine. romberg tested okay. the ent reviewed ct scan and believed with 95% certainty that i did not have a dehiscence because you can see some white haze/outline around the semicircular canals. my symptoms are as mentioned before: chronic dizziness (like my head is filled with helium), movement provokes it but also makes it go away while i am activley moving. no symptoms with loud noise. i have had tinnitus since i was a teen, no change in that. sometimes i fell a small amount of over sensitvity to a phone ringing or some peoples voices. my ent said to take wait and see method, no exploratory surgery. what is your opinion? thanks, steve.


Hello,

Your VEMP showed reduced asymmetry. You have chronic giddiness which worsen and improves with movement.

You do not have symptoms suggestive of superior semicircular canal dehiscence. Same time CT temporal bone did not show any obvious dehiscence. I believe it was kept in consideration for diagnosis due to previous abnormal VEMP which was done as test battery for giddiness not particularly to diagnose SCC Dehiscence.
Abnormal VEMP can be due various pathology including BPPV/Meneires disease/migrane etc.
With all details still I think you have recurrent BPPV which is less in severity compared to previous one.
So you can follow wait and see safely and you can plan for air travel also.
Hope this helps, feel free to ask further queries.

Best regards

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


Patient replied :

Hello again, Everything I have read in the past states not to drink caffeine in regards to vestibular disorders. Today I had a cup of coffee and it virtually eliminated my symptoms. Why? Is this suggestive of some other diagnosis? Also is it safe for me to have some caffeine? All literature I have read recommends not to. Will it increase my chances of getting BPPV again? What are your thoughts about taking 5mg of Valium before I go to bed, will it interfere or undo vestibular compensation? Thank you Steve


Hello,
caffeine doesnt have significant effect on vestibular disorders. if your symptoms improves with cup of coffee, you can drink it. It will not increase changes of getting recurrent BPPV.
Valium will not effect central compensation. If you have sleep disturbances you can take valium as and when required.
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 :

Hello,
Caffeine doesnt have significant effect on vestibular disorders. if your symptoms improves with cup of coffee, you can drink it. It will not increase changes of getting recurrent BPPV.
Valium will not effect central compensation. If you have sleep disturbances you can take valium as and when required.
Hope this helps, fell free to ask further queries.
Best regards

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



Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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