Vertigo & tinnitis

[mh51867]

I'm 40 years old, and for about two years I've been dealing with random but troubling symptoms. I've been to a battery of doctors, and have had every test known to man run, with no conclusive results, no diagnosis, no help or abatement of any of the symptoms.

Symptoms:

Tinnitus - all the time. Sometimes screaming loud, sometimes it quiets down. It's a high-pitched whine, and as far as I can tell in both ears. I've been to an audiologist and have had extensive testing done. Nothing physically wrong with my ear canals or hearing parts. Sometimes the tinnitus is so loud it gives me a horrible headache and it always impacts my hearing on some level. It's been my constant companion for no less than a year.

Vertigo. At times extreme to where I have trouble walking across the room without holding on to something. It's not often this severe, but when it is this severe, I find that I am struck with extreme fatigue very shortly thereafter. These bouts will last for about 2-3 days where I have the extraordinary vertigo, and could sleep the entire day away (type A personality - not normal for me). When this is going on, I experience extreme nausea as well, even when laying down and not experiencing vertigo. I should mention if I lie down, the vertigo doesn't happen.

On an on-going regular basis, I experience vertigo when I take the first couple bites of food. The entire room will swim and if I were standing, I would fall over. This happens every time I eat. Recently it has begun happening when I take a drink as well (the first couple drinks when I start drinking water for example). This symptom has gotten worse recently. It didn't used to ever happen with liquids I drink, and the episodes with bites of food used to last 5-10 seconds and now last a good 20-30 seconds.

I feel as if I have a golf ball in my esophagus. A lump in my throat (but below my throat) that never goes away. It literally feels difficult to swallow a large bite of food because of this.

Extreme fatigue. As mentioned above, I go through bouts of fatigue that need to have some other moniker. I literally feel like I can't raise my head I'm so exhausted. Bone weary is a better term. This lasts for several days when it hits. I truly feel like whatever is wrong with me, this is a by-product, or aftershock, if you will, of whatever is happening to me.

Insomnia. I also have bouts of insomnia that will last for several days. This is just within the past 6 months or so. Never in my life have I had trouble sleeping before.

Tests I've had:

Neurological consult. He felt I probably had Meniers and was pretty much a jerk who told me my cluster of symptoms were strange and sounded psycho-sematic. However, I did follow up with an ENT who specializes in meniers, and it's not meniers.

I also saw an audiologist and had a huge battery of tests (not just hearing tests) done to test inner ear, outer ear, etc., etc. They truly ran every test they could since it is logical to think this is ear-related. I was found to have nothing physically wrong with my ear parts, and my hearing was within normal range - possible very minor hearing loss in one ear, but inconclusive.

MRI. Result was that I do have a Chiari Malformation. The above-neurologist who was condescending and dismissive about my "psycho-sematic" symptoms thought the Chiari Malformation to be a non-issue. Yes, it's there (he said as he read my MRI), but it couldn't possibly cause any of these strange cluster of symptoms.

Thyroid. I've often felt many of my problems could possibly be thyroid related. I could check "yes" off on every hypothyroidism symptom, and yet bloodwork has come back two times as normal. (My internal medicine doctor couldn't believe it wasn't my thyroid, so he re-tested). I didn't list all these random little symptoms here, because I don't think they're related? But in case they are: I've lost my outer eyebrows - they were full, now they're bald. I'm always cold, even in summer, I've gained a great deal of weight in the past year; I have heart palpitations (I wore a halter monitor and was found to have sinus taccychardia and sometimes irregular heartbeat, but they could find no reason so it was determined to be probably low-potasseum); I get dizzy if I get up too quickly from sitting or laying.

Other bloodwork. I've been tested for diabetis, hypoglycemia, anemia. I am borderline anemic - always have been my whole life, tho, so this is nothing new. Everything else, normal.

That's my story. The symptoms are literally starting to take over my life and I'm so frustrated! I've done everything I can to find an answer, and no answer comes.

If any of this rings a bell or if anyone has any suggestions, I would love to hear them. I'm proactive, live a full life and want to get at the heat of these symptoms so I can start to feel normal and well again. Instead things seem to be heading further and further south.

thank you in advance

[mh51867]

Thank you so, so much in advance for taking my question. The more eyes that see it, the more chance that someone will read it and recognize something in what I've written to give me a clue as to where I might go next to try and get help or answers.

As I thought more about my situation last night a couple more things I neglected to mention came to mind.

I didn't mention, but I also had a swallow test (I believe that's what it was called). I ate bites of food with different consistencies (liquid, pudding, crackers) while being x-rayed. The test was run for my upper throat, right where you first swallow. They found nothing. When I told the doctor administering the test that the sensation was lower in my esophagus, he moved the focal point and looked at it and said he could clearly see some sort of muscular hesitation, but couldn't test for it because the order written was to test my upper esophagus so he couldn't pursue it - that I needed to have my doc write up another order for lower (or mid?) esophagus swallow test. I haven't done that yet.

Another symptom I didn't list, but which is a biggie is brain fog. I feel like thinking is like slogging through thick mud. It's hard for me to come up with words (and I'm a very, very articulate person. So much so, that people have teased me my whole life for using big words). Now I have trouble completing sentences. I'm CONSTANTLY seeking the word. I see the object in my brain, and I concentrate and search and search for the word. It's always just out of my reach.

Last but not least, I have trouble understanding people speaking. I don't know how to explain this other than to say I have to concentrate VERY hard to understand what people are saying. At first, I 100% attributed this to tinnitus and that it was difficult for me to hear them. But as I've spent the last couple days really thinking about my issues and this one in particular, I've been trying to really monitor this symptom. In truth, what it feels like is more like there's a veil in between the person speaking and me. I have to look at them and concentrate really hard to "hear" what they are saying. This might sound very strange, but it FEELS disproportionate to hearing problems I may or may not have (due to tinnitus). It feels more like the person speaking has mush in their mouth and I just want them to speak more clearly and to speak up. I'm continually asking my kids / husband to repeat or say it louder or more clearly.

Also about 1.5 years ago I was diagnosed with Macular Degeneration. Probably not at all related, but I mentio it just so everything is out there.

Thanks in advance again. Just wanted to add those additional facts.

[clinicalguru3]

Have you had a BAER test (brainstem auditory evoked potentials )?..this test can measure the pathways of the auditory nerve right until the brain.
Have you had an EEG?
Did anyone perofrm a Dix=Hallpike test on you? This is where they make you lie down and sit-up to try and re-create the dizziness so they can look at your eyes at the same time.

Was nystagmus (abnormal eye movements) noted by anyone.....if you really see the world spinning around you then this would be noted (at the time ) on examination...if this happens again (or if you know how to make it happen) it may be worth someone filming your eyes to see how they are moving when you experience the spinning snesation in your vision.

DO you have the MRI that you you can attach to your reply?

[mh51867]

Regarding audiology testing, when I went to the audiologist, I had a bunch of hearing tests that were performed, and at that time they scheduled BAER testing and otoacoustic emission testing. When I went back to discuss the results of the preliminary testing, they told me I didn't have hearing loss, and so in their opinion I didn't need to keep the scheduled BAER and otoacoustic emission tests because a loss of hearing would indicate further testing is necessary.

I had told them at the time my hearing is not consistent. I will have bad days where I am constantly asking people to repeat, I'm turning up the volume on the TV, and things are just muffled, etc. - and then days where I seem totally normal with my hearing. I think my hearing tests were done on a day where things weren't muffled. Unfortunately I can't "make it happen", it just does or doesn't. The tinnitus is there 24/7 tho. Sometimes barely noticeable, sometimes just screaming loud.

I have some images from my MRI, but not my actual MRI. The audiologist actually asked me for the copy I had and has not returned the CD. I'll load the images I do have, although I'm not sure how helpful they'll be.

I have not had anyone perform a Dix=Hallpike test, nor look for or note any nystagmus. When I went to the neurologist, he asked me a lot of questions, asked me to do tests that seemed just like the sobriety testing a police officer does (walk a straight line, touch my nose with my finger), and he tested my reflexes. That was the extent of the neurology visit. I asked him to look at my MRI (requested by my internist) and he did look at it, and said yeah, you have a Chiari Malformation - looks to be approx. 8 centimeters - but that couldn't possibly be causing any of the symptoms you describe. It's a non-issue.

I also have not had an EEG.

Thanks for your attention. I really appreciate it - any direction you can give of possible avenues I can try to pursue for answers would be greatly appreciated. I'm not a doctor, but my symptoms are all neurological, and they're worrisome to me. I worry that I could have a schwannoma/acoustic neuroma, or a syringomyelia. I just know my symptoms aren't just from "stress" or "getting older" and I feel so helpless because no one will take them seriously and act like I'm crazy for worrying about either of those as a possibility.

[mh51867]

two more MRI images...

[clinicalguru3]

The MRI pixs you sent are not the best view to see the Chiari malf...but I would not expend any more effort on this although I would like to see the official MRI report.

I would consider performing a BAER and EEG to further investigate your symptoms. In my opinion all physical symptoms are affected by psychological factors...in other words, just because someone is stressed / worried and their symptoms worsen with this, it does not mean that the whole issue is anxiety related and also does not mean that the psychological issues should not be dealt with! If you are excessively worried and stressed then this should be dealt with in any case! It does not mean you are not feeling what you are feeling...the feeling are real.

You may find more on this subject at http://www.asktheneurologist.com/Anxiety-neurology.html and also a related thread (the main concepts may be relevent to you though clearly the disease is totally unrelated) http://www.asktheneurologist.com/scared-its-ALS.html.

hope that helps