Since having the flu and a sinus infection in May 1995, I have experienced constant dizziness, vertigo and nausea. There is also a high pitched noise in my left ear and I feel tired a lot of the time. This concerns me as prior to this, I had been a very fit and active 29 year old male.
My GP diagnosed viral labyrinthitis and this was confirmed by an ENT surgeon and a neurologist in the following months. I was told that it could last for up to 6 months. I was prescribed various anti-nausea drugs but these did not work. The neurologist thought that there may have been a blood supply problem to the inner ear and so prescribed propranolol. This also did not work and so he arranged an MR scan for me. This did not show anything sinister.
In the meantime, I tried acupuncture, a variety of herbal and homeopathic medicines and vitamin supplements.
In February 1996, I came across an article in a medical journal about benign positional vertigo. The article described a series of head movement exercises to help direct any debris resulting from the viral infection to the larger chamber in the inner ear. This also did not work.
In June 1996, my GP referred me to a specialist balance centre at a major neurological hospital in London, England. Following a series of tests involving a rotating chair, electrodes attached to my head, hearing tests and water being poured into my ears, the neurologist concluded that either the left balance mechanism or the nerves at that location had been damaged by the viral infection. He prescribed a series of exercises called the Cawthorne-Cooksey exercises. The theory behind the exercises is that by inducing vertigo, the brain will learn to compensate for the confusing signals coming from the left side by 'central compensation' after a period of time.
I have been dilligently carrying out the exercises for 12 moths now and although there has been a slight improvement, the dizziness, vertigo, nausea and fatigue persists. I have also noticed that my left ear aches from time to time. This in itself does not bother me but I am mentioning it to give the full picture.
Having had the problem for over 2 years now, I wonder if anyone could advise me of how much longer until it goes away. I would also like to know whether any surgery would be advisable and what are the risks.
Yours Faithfully,
Reply: -------------------------------
Clearly you have had an extensive and thorough evaluation conducted in a manner that seems logical and quite appropriate. Unfortunately it has not resulted in satisfactory improvement in your symptoms. It seems clear that you have a chronic inner ear disturbance that is not responding in the usual manner to interventions that are generally successful in the majority of patients with similar symptoms. In situations where inner ear disturbances are chronic, fail to respond to the usual measures, and cause vertigo that interferes with daily activities, it would then be appropriate to consider surgical or invasive procedures providing one is an appropriate surgical candidate and has no other medical conditions that might contraindicate surgery. There are a variety of surgical interventions used in the treatment of chronic disabling vertigo. Some are selective - addressing only the portion of the inner ear that is dysfunctional. Others are more generally ablative. There are procedures in which medication (streptomycin) known to be toxic to end organs of the balance system is infused directly into the inner ear. There are procedures in which a nerve branch of the inner ear responsible for balance function is cut (vestibular nerve section). For severe incapacitating vertigo in which there is also severe non-serviceable hearing loss, a more radical ablative procedure is occasionally recommended known as a labyrinthectomy. These are procedures typically done by otolaryngologists with special experience in otology or neurotology.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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