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UNILATERAL PULSITILE TINNITUS, pressure behind ears. LYME disease.

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45 y/o male, excellent health. 10 weeks ago unilateral pulsitile tinnitus, pressure behind ears and mild-moderate headache started in back of head. No nasal discharge. GP gave z pack and 6 day predisone. No effect. However a few days after stating meds developed insomnia, wired feeling and vibrating/slight shaking feeling in neck and back, not painful, most noticeable when laying down. Also strong sensation of pulse in back of head, neck (loud thumping sound in both ears when against pillow) and sometimes chest. ENT ordered head MR & MRA w/contrast. No issues. Over next few weeks vibrating feeling almost gone, other symptoms slightly improved. Realized moved into new house which had been closed up tight for several months around onset of everything. Last week had skin test which showed highly allergic to most things (outside and inside allergens). Started Nasonex and Azelastine. Now PT essentially gone, headache/pressure is variable by day but moderately better, vibrating feeling almost as bad as before. A couple questions. Do you think vibrating is reaction to steroids? If not, then what? New house is in wooded area in Ohio, I am often in woods. Any chance for Lyme? Any other suggestions in general?


Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Rajiv Goel is online now

Expert:  Dr. Rajiv Goel replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com

You have a cyst within the prostate. This cyst can be prostatic utricle cyst. This cyst has been with you since birth. The cyst can lead to poor urinary flow and also painful ejaculation. If there are symptoms then you can start yourself on flomax under the care of urologist.
The second possibility is ejaculatory duct obstruction. The patient shall have similar ultrasound findings. The amount of ejaculate is very small. The treatment for such patients shall be transurethral resection of ejaculatory duct.
Feel free to discuss further,

Take care
Sincerely
Rajiv Goel


Patient replied :

I had semen analysis before because my wife and I were not achieving pregnancy and my analysis came out as great. My wife, however, always maintained that my ejaculate was way too little. The fertility clinic we visited concluded it was her age - 38 - and therefore went with IVF. This resulted in an ectopic. But we wanted do try again and then I had the problem of no ejaculation at all. What will the procedure mean to my fertility? How long after it can I have intercourse or give sperm for IVF?

Thanks


Expert:  Dr. Rajiv Goel replied 3 Days.

Hello,
You should undergo MRI pelvis.
If MRI shows ejaculatory duct obstruction then the procedure shall remove the obstruction and you shall start having ejaculate again and hence pregnancy shall be possible either with intercourse or IVF.
You can also undergo aspiration of sperms directly from the testes and IVF with the same.

Feel free to discuss further,

Sincerely
Rajiv Goel


Patient replied :

How long do I need after the procedure to be able to have intercourse or give sperm for IVF?


Expert:  Dr. Rajiv Goel replied 2 Days.

Hello,
Thank you for your follow up at DoctorSpring.com
If ejaculatory duct obstruction is identified on MRI, a plan for transurethral resection of the ejaculatory ducts is made. The procedure would unroof the ejaculatory duct cyst and open the ducts thereby allowing for normal flow of ejaculate and improvement of ejaculate volume.
This may assist you in being able to conceive naturally without assisted reproductive technology such as IVF.
As to the timing when you can have sexual intercourse after the procedure, would be shortly afterwards (within 5 days) provided surgery goes smoothly. A formal semen analysis is examined at 2 weeks and at regular intervals thereafter until semen quality stabilizes.
Hope this helps, feel free to discuss further


Patient replied :

Thank you. Last night I was not able to urinate and was in some pain. Then I was able to but brown urine came out; the subsequent urination attempt was brown but not as dark. Now my urine is clear and the flow is great; it hasn't been like that in a while. What could have happened? Could the cyst have dislodged? I am away on a business trip and don't want to see any doctor.


Expert:  Dr. Rajiv Goel replied 1 Day.

The internal echoes in the ultrasound suggested that there has been some bleeding in the cyst. The bleeding shall swell up the cyst and make symptoms worse.
Now that the blood has come out, you shall feel better.
No need to worry and no need to see any doctor at this point of time.
Hope this was helpful,

Sincerely
Rajiv Goel


Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
DNB - NBE
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
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