Have Had Vertigo Symptoms. Having Squishing Sounds In Head And Cracket Sound In Ear. MRI Test Normal. Cause

Posted on Wed, 29 May 2013

Question: For two years, I have had Vertigo symptoms in my head. I started with two debilitating vertigo attacks. I went to an
Audiology facility. They thought it might be "crystals" were out of balance. This condition has continued. I have continued "brain fog", squishing sounds in my head and crcket sounds in my ears, especially at night. I have been to an ENT doctor, vascular testing, MRI for brain scan and my GP. They cannot pinpoint any particular cause. Perhaps you can give me some ideas. Thank you.

Answered by Dr. Sumit Bhatti (2 hours later)

Hi,

Thank you for your query.

1. BPPV (Benign Paroxysmal Positional Vertigo) is a spinning sensation which occurs due to displacement of crystals in the semicircular canals of the inner ear is fairly easy to establish. If the vertigo occurs on change of head position with respect to gravity such as while lying down or getting up, turning in bed or looking at a high shelf (top-shelf vertigo), it is BPPV and treatment includes re-positioning exercises and maneuvers. It is estimated that one in three people over the age of 60 experience BPPV at some point and about one in 5 cases of vertigo is of BPPV. Sometimes a VNG (Videonystagmography) is required to help in the diagnosis.

2,. Another important condition to rule out is Meniere's Disease. Meniere's disease is diagnosed on the following criteria:
a. Vertigo
b. Fluctuating hearing loss
c. Tinnitus
d. Fullness in the ear
There is usually nausea and vomiting during an attack, the hearing usually worsens during an attack and the tinnitus also worsens.

3. Do you have history of any illness - ear / neck related problems or head injury? Any headaches or migraine? Any hyperacidity or recent cold?

4. I will be able to guide you better about the possible cause if you can provide me more details of your dizziness like:
a. The exact moment when it all started,
b. How often and how long do the episodes last? Is it continuous?
c. Any other associated symptoms, such as nausea, vomiting or sweating?
d. I need to know if your hearing is normal. Does it fluctuate? Do you get any sounds (tinnitus) or fullness in the ear?
e. Is the dizziness true vertigo (spinning of the surrounding) or only unsteadiness.
f. Is the dizziness only when there is change of position (such as lie down or sit up)? Can you walk without support? Do you get dizzy when you turn in bed or look up while climbing stairs?
g. Is your vision clear or blurred? Is there any tendency to blackout?

5. It is also important to consult a neurologist to rule out neurological degeneration that can cause such symptoms. (MRI scans may not be enough to pick these conditions).

Awaiting your reply.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (21 hours later)

My two vertigo attacks came in 2011 around September or October. I was in the process, along with my daughter, of tending to my husband of 52 years, due to his Cancer. It was a very stressful time in my life. I lost a lot of sleep and generally felt very "worn out". Had hard time sleeping. I would not really call my condition at this time "Vertigo". It is more "unsteadiness" and my head always feels "full" and my balance is affected. I CAN drive without any problem, however, there are days when I just don't get much done all day. I mostly have the FULLNESS feeling in my head along with the "squishing" sounds at various times. I even have some allergy symptoms, such as sneezing,etc. I live in Georga, so the pollen count has been real high here, however, after some extensive rains, it is getting better. I do feel like my head is "very full" and hazy. Many years ago, I did have my left ear flushed. It had a pretty good sized piece of "wax" in it, which was flushed. I would think that after all of my appts. with my GP and two appts. with an ENT doctor, they would have recognized if I had a "stopped up" ear or ears. A couple of times I took some Zyrtec for allergies, however, I don't think I noticed any relief. Since I take Lisinopril, 10 mg one daily and Bisoprolol-HCTZ 10-6.25 mg., one daily, I was wondering if these could possibly cause the "fullness in the head" since my blood pressure is good. I have been talking both of these for many years, so I never have experienced problems, however, I have heard of people having dizziness from too much b.p. medicine. I don't really have a a spinning sensation, just the haziness in my head. I went to a neurologist about 6 mos. ago. He looked at my chart from my G.P. and just said" You don't have a neurological problem". He didn't even take time to examine me. I have had all the testing associated with these symptoms, however, I have never had the brain scan which you suggested. I am totally puzzled. I never feel nauseated. My neck sometimes has periods of real tightness. Since I have been under quite a bit of stress for the last few years, I just feel that is what has brought all of this on, not withstanding the fact that "I am getting older".

Answered by Dr. Sumit Bhatti (12 hours later)

Hi,

Thank you for writing back.

1. Get a Neck Color doppler study done to check the blood supply to the brain. Cervical X-rays may be done to check the cervical spine since you have episodes of neck muscle tightness. In particular, Basilar artery insufficiency should be ruled out.

2. Ear related vertigo is mostly the 'spinning' type. With 'unsteadiness', central (brain-related) causes must be ruled out.

3. Your Lisinopril is an ACE inhibitor, Bisoprolol is a beta blocker and hydrochlorothiazide is a diuretic. These symptoms may be drug induced.

4. Get your routine blood tests including serum electrolytes, sugar levels, thyroid levels, homocysteine and vitamin B12 levels checked.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar