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TINNITUS, HYPERACUSIS, dizziness after hitting head. COCUSSION?

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The question to Neurologist and/or ENT doctor

I hit my head 1 month ago. My head injury was only minor - I hit the top of my head when walking past the bus stop - I hit the rear vision mirror on the bus. I did not lose consciousness, had no pain, no bruises, no headaches or anything major. I am not sure if I suffered a minor concussion or not.

After the event, I have had tinnitus (mild buzzing in the ears), hyperacusis (low tolerance for loud noise and high frequency sounds) and dizziness. All symptoms are persistent over past 4 weeks.

I did CT scan and MRI scan of the brain - all completely normal.

I also saw an ENT specialist too and did a hearing test. It was within normal limits. Only a small problem in high frequency range.

My stress and anxiety are enormous. I have not slept for almost one month (only 2-3 hours a night on average). I think about this event 24/7 and I am completely obsessed by it. I am worried that I have damaged something but don't know what. I have no pain but cant sleep due to worry and anxiety. I lost 5 kilos due to stress and lack of sleep. My general health is affected due to constant stress.

I started taking herbal pills for sleeping - only a small effect. I also started taking Endep 10 (amitriptyline) for better sleep but have stopped taking Endep it as I thing my dizziness and tinnitus got worse after it and I don't sleep much better.

I also started taking fish oil (omega 3), vitamin B complex, magnesium, zinc and gingko biloba supplements - no improvement. I discontinued herbal pills today as I think they are useless. I started feeling much more dizzy after taking magnesium 3 times a day so I stopped it.


MEDICAL HISTORY: I had quite a bit of vertigo and small tinnitus 7-8 years ago too. It was for a few months only and I believe it was induced by work stress. This was resolved by itself long time ago- there were no clinical findings of any diseases.


What is the cause of my tinnutus, hyperacusis and dizziness?

Is it an injury to brain and inner ear? Is it temporary or permanent? What neurological tests or inner ear tests should I do to find a real cause of these problems? Is my hyperacusis, tinnitus and dizziness going to stop and when?

Or is it largely driven by my enormous stress, anxiety and lack of sleep and not by any injury to my brain or inner ear? And maybe when I stop worrying, the symptoms will reduce too?

What should I do? Which doctor should I see? Is it neurological, ENT or psychological problem or all of it?

Should I take any herbal supplements?

How can I restore my sleep? - I didn't have a proper rest for 1 month.

Thanks for your help

Goran

Category: ENT Specialist

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Category: ENT Specialist
 30 Doctors Online

Hello,

Thank you for posting your query at DoctorSpring.com
I can understand your problem.

You are suffering from Tinnitus, hyperacusis and dizziness since one month following head injury. Your CT, MRI brain normal. Your audiogram normal except mild high frequency hearing loss.
Please write more details about your vertigo.
It is episodic?, is there any positional change(worsening on turning head or lying down)? Any other aggrevating or relieving factor.
Duration of episode of vertigo
Do you have any associated nausea or vomiting.
Tinnitus is usually occurring with high frequency hearing loss. Same time we can have hyperacusis also.
Some time all these symptoms can happen with perilymph fistula with may be due to trauma, which can be confirmed with HRCT Temporal bone.
Few other investigation can be done including ENT, ECoG at audiology centre.
As your MRI brain in normal you need to worry about any serious injury, though I know present symptom are effecting your quality of life very much.
Endep 25 mg will help in sleep disturbance and to alleviate anxiety.
You can start betahistine 16 mg three times daily , it will help in both vertigo and tinnitus
Ginkoba bilovas also has good evidence to provide relief in tinnitus , you can take to twice daily.
For detailed evualation you can consult a neurootologist (ENT specialist who is running vertigo and hearing clinic)

Hope this helps

Best regards

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


Patient replied :

Hi again,
My local neurologist told me that permanent damage is unlikely because the head trauma was small, CT and MRI scans and normal and I have no other symptoms but mild dizziness, tinnitus and hyperacusis. He said the symptoms will disappear in 1-3 months.
How can I be sure the symptoms are only temporary? Is there any objective vestibular or audiology test which can be performed to confirm if there is any nerve damage and fluid likage? What is the best test for this?
Is HRCT Temporal bone going to show anything more than MRI?
Or are these changes too small to be reliably detected by any test / scan?
Are there patients who hit their head, have temporary dizziness, tinnitus and hyperacusis, and then recover completely in a few months? What is the common duration of these symptoms after mild TBI? It doesnt's have to be permanent, does it?
Thanks
Goran


Hello,

Your symptoms may be temporary. To get correct diagnosis these investigation may help. HRCT temporal bone can pick up superior semi circular canal dehiscence and perilymph fistula even it can be missed with MRI brain.

ENG and ECoG are objective vestibular test only, it will help in getting correct diagnosis.

All these symptoms can improve spontaneously in may patients following head injury. Usually patient recover fully between 3-6 months

Hope this helps

Best regards


Patient replied :

Hello
What should I do to allow recovery?
Should I stop doing all sports? Are long walks ok?
Should I avoid all sudden movements of the head?
Should I stay in bed longer?
Should I avoid air travel because of pressure changes?
Should I avoid listening to loud music? How loud is too loud? Can loud music, eg piano concert, can cause further damage?
When is it safe to resume all activities?
Thanks
Goran


Hello,

Post traumatic symptoms usually improves spontaneously with in 3-6 months

You can walk or run safely

You should avoid sudden movement of head as it can aggregate giddiness

Air travel should be avoided if possible

You can hear music, avoid very loud( >90dB)

You can resume all activities

Hope this helps

Best regards


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


Patient replied :

Hello
Why is air travel dangerous? What are the risks for my ears and balance? Is it gonna help if I wear noise cancelling headphones?
I have tickets for 2 short flights in Dec and Jan. Should I cancel them?
What should i take for better sleep? I used to take Endep. Now i am taking Valium which may be addictive. I am told both of these medications are ototoxic - can damage my hearing..Is it true? Is Melatonin also risky? is there anything better and less risky for sleep?
Thanks


Hello,
Folllowing a head injury, we normally advise patients not to travel via flight if possible.
The reason being the ET dysfunction which is seen following head injury leading to a plethora of symptoms such as dizziness, tinnitus, loss of balance, e.t.c
If they are shirt flights it's fine. Noise cancelling headphones won't be much useful since once you go higher up during taking off for instance immediately the pressure inside the ear changes and the Eustachian tube needs to change and maintain the ear pressure accordingly. So if they are important trips go ahead, provided the flights are not of long duration.
Also you can take Valium, it is not ototoxic. Some studies claim, i am yet to come across a case having ear problems due to valium use. Less riskier will be Tab. Alprazolam 0.5 mg, once daily before sleeping, it causes lesser withdrawal symptoms, is helpful in inducing good sleep and alleviating anxiety.
My sincere request to you will be get yurself evaluated by a neurootologist as i mentioned in my previous follow up who can examine you locally.
Wish You great health.
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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