Hi,
Thanks for taking a look at this post. I appreciate it very much. If you feel you may drop me a line with some advice, this is also greatly appreciated.
I started feeling vertigo on the 6th of December of 2007, some 2 1/2 months ago. I would actually better define my condition as unsteadiness or imbalance.
I am a male of 31 years old with no significant previous history, except for three otitis media -one very acute and long lasting- some 4 years ago . Also some family (paternal aunt and grandmother) cases with serious affections of the ear.
Summary of symptoms: unsteadiness condition; more precisely, great difficulties to stay standing up without walking -sensation that I have to concentrate in order not to lose balance; some difficulties to stay sitting up on chairs; mild difficulties to walk (sensation of soft and irregular surface sometimes, no abnormal sensations some other times); some difficulties to maneuver (cook, shave,...) but mainly because of staying standing up; occasionally dizzy -but not much- while being in positions other than standing up or sitting up; no significant exacerbation with sudden movement; some difficulties to look up to top shelves or buildings; occasionally headaches, but neither frequent nor strong; never fever; never strong nasal congestion but some irritation of throat and mild congestion of nose at some points in time; no lightheaded; no hearing loss; no nystagmus; no tinnitus.
My symptoms have evolved as follows (skip this "section" unless you are very interested, because it's somehow tedious
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Day 1: Overall feeling that it was hard to stay standing (in the evening).
Day 2: Difficulties to stay standing as well as to maneuver, mostly cooking or typing (in the evening). Everything got resolved by sitting on a couch.
Day 3: Impossibility to stay standing or sitting up since the very moment I woke up; overall dizziness sensation in any position.
Rest of week 1: overall sensation of dizziness, as well as inability to stay standing or sitting up in a straight position. Mild trouble walking. Some nausea while trying to sit up (to eat, for instance).
On mezclizine (antihistamine) for a week with no perceived improvement.
Week 2: reduction of the overall dizziness condition, but continuation of the inability to either staying standing or sitting up in a straight position, as well as some mild trouble walking (sensation that I am walking on an irregular soft surface at times, sensation of instability some other times, no major problems some other times). Intake of Serc, prescribed for Menière Syndrome, with no apparent improvement.
Week 3: almost no dizziness (probably due to intake of diazepan, 5 mg at nights), but continuation of the main symptoms: difficulties to stay standing up without walking and also to sitting up straight in chairs (no problem while sitting on a couch, slightly inclined down).
Week 4: amelioration of the symptoms, still involving some trouble to staying standing or sitting up on chairs.
Week 5: dramatic return to symptoms as in week 2 (at this point, I was to return to my job activities and due to the impossibility, lost my income and found some trouble to keep my medical insurance; hence, I was under big stress)
Week 6: Slight amelioration of symptoms, but still difficulties to stay standing up or sitting up.
Weeks 7-10: Overall tendency to improve but some days I get worse, back to the most acute symptoms; still, even in good days, find trouble to stay standing up without walking and, sometimes (less and less so, though) find trouble to sit up on chairs. Intake of Prednisone (corticosteroid) on week 9 for 6 days with the following response: first two days, no significant change; 4 last days, back to acute symptoms again; 2 days after intake, back to usual symptoms
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Tests that I have been performed:
Normal vitals in emergency room on day 3.
ENT number 1 suspects that some inner ear trouble is causing the unsteadiness, but does not perform any exploration. Refers to neurologist and orders an MRI to rule out other cases.
Normal MRI, but observation of upper sinus tract inflammation and also abnormally big vessel (apparently non-pathological). This was performed on the first week.
Normal neurological (neurologist number 1) examination, within first week.
ENT number 2 (in Spain, my home country) performs exam in week 2 and rejects that the inner ear is causing the unsteadiness. Suspicion of central vertigo and referral to neurologist.
Neurologist number 2 (in Spain also) performs thorough tests and rejects central vertigo.
ENT number 1 sees me again in week 5 and continues to point at inner ear, but does not perform any exploration or test whatsoever. Recommends time to get better.
Psychiatrist suspects somatic vertigo and decides to put me on anti-depressants (cymbolta), believing that I may have a depression (or anxiety). I don't believe I have, but I start doubting everything! I decided to wait for a month before taking cymbolta (I have not taken it yet -may not take it at last)
ENT number 3 (recommended by a Psychologist to get another opinion) orders a blood test, an Electronystagmography (ENG), an Electrocochleography (ECOG), an Auditory Brainstem Response (ABR) and an Audiometry. All tests results are entirely normal but the ENG, that reflects a diminished response of the left ear in the caloric test (BINGO!?). His diagnosis is a possible inflammation of the left inner ear or left vestibular nerve. The treatment is none: just wait.
DOUBTS:
1- Should I be sure that the entire problem rests on the left vestibular nerve just because there is an abnormal response, as showed in the ENG caloric test?
2- If so, does this test reflect that I may have vestibular neuronitis/neuritis (the ENT said that labyrinthitis or other sort of inflammatory process may also be the underlying cause)?
3- Is it normal that almost 3 months after I am still unable to stay standing up normally?
4- Is waiting a good idea? What about Vestibular Rehabilitation? Would that be indicated for my condition?
If you have read up to this point, sorry for the torture of this long text. Thanks for your patience.
Sergio
