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Is Vertigo From Middle Ear Problem Or Cervical Spondylosis?
Dear XXXXXXX,
Thanks for writing in.
Hello I am Dr Ravinder Sharma ENT Surgeon. I have gone through the information provided. I have some more questions and then I will be able to answer your questions
1. Do you have headache in association with these symptoms?
2. Have you ever been on medication for Tuberculosis or any medication for a long duration?
3. Please tell me if you are suffering from Diabetes or Hypertension?
4. The duration of the episode of vertigo you experience. Any association with vomiting?
5. Can you send the images of your audiogram and tympanogram?
6. Any history of recurrent nose block or nasal discharge or nose bleed?
7. Any family history of similar illness in your siblings or parents?
8. Have you ever undergone thyroid function tests?
I am waiting for your answers and I will be in a better position to answer your queries
Vertigo is a symptom which can be attributed to ear disease, Nervous system disease, cervical spine disease or eye problem. Apart from this, there can be systemic causes like anemia, diabetes, high blood pressure.
The kind of description you have given is more suggestive of a cause in ear but I would be answering your queries as soon as I get the answers to above questions
with warm regards
Ravinder Sharma
Thanks for writing in.
Hello I am Dr Ravinder Sharma ENT Surgeon. I have gone through the information provided. I have some more questions and then I will be able to answer your questions
1. Do you have headache in association with these symptoms?
2. Have you ever been on medication for Tuberculosis or any medication for a long duration?
3. Please tell me if you are suffering from Diabetes or Hypertension?
4. The duration of the episode of vertigo you experience. Any association with vomiting?
5. Can you send the images of your audiogram and tympanogram?
6. Any history of recurrent nose block or nasal discharge or nose bleed?
7. Any family history of similar illness in your siblings or parents?
8. Have you ever undergone thyroid function tests?
I am waiting for your answers and I will be in a better position to answer your queries
Vertigo is a symptom which can be attributed to ear disease, Nervous system disease, cervical spine disease or eye problem. Apart from this, there can be systemic causes like anemia, diabetes, high blood pressure.
The kind of description you have given is more suggestive of a cause in ear but I would be answering your queries as soon as I get the answers to above questions
with warm regards
Ravinder Sharma
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Dear Dr. RAvinder SharmaGaru,
Namaste. I am hereunder giving detailed information for your perusal and kind and valuable advise in the matter.
ANSWERS TO YOUR QUERIES
1.Do you have head ache in association with these symptoms?
No. not at all.
2.Have you ever been on medication for tuberculosis or any medication on long duration
I never on medication for tuberculosis. But the following medicines are being taken
Had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then
Had mild Hypertension in the year 1980 (under control)
Had prediabetes in the year 2010 (IFG) (under control)
Had subclinical hypothyroidsm in 2011
Medicines now being used
Heart * (from the year 1977)
STAMLO BETA 50 MG Stamlobeta 50 mg since 2006
ISMO 10 MG One tab Twice a day since 1996
Tg Tor 50 MG One tab Once a day after dinner since
1996
ASA 50 MG One tab a day after dinner
since 1991
Type II diabets
GLYCOMET 250 MG One tablet in the morning since 10 days (previously half tab in the morning in the morning and half tablet in the night )since 2010)
Sub clinical Hypothyroidism
THYRONORM 75 MCG One tab once a day since july 2011
3.Please tell me if you are suffering from diabetes or hypertension?
I had prediabetes from the year 2010 and mild hypertension from 1980, but it was well under control.
4..The duration of the episode of vertigo you experience.Any association with vomiting?
On both the occassions, it was severe for a day or two, but later on became mild. No vomiting. But in the second spell I felt nausea for a few seconds along with spinning of the room.
5.Can you send the images of your audiogram and tympanogram?
Attached photographs of the both separately
comments of audiologist:
(Right ear)SISI Non significant Tone decay Negativescan ABLB satifactory
(left ear) SISI Non significant ABLB ---TONE DECAY Negative scan.
Provisioonal diagnosis: Right: borderline hearing with high frequency SN dip
LEFT : Moderately severe damage. mixed hearing loss
6.Any history of recurrent nose block or nasal discharge or nose bleed?
No nose block or no nasal discharge or nose bleed experienced at any time
7.Any family history of similar illness in your siblings or your parents?
None had this in my family
8.Have you undergone thyroid function tests?
Yes I had hypthyroidsm in July 2011. TSH is is little bit HIGH (10) previously. T3 and t4 are normal.enclosed the result.
TEST REPORT DATED29/2/2012
T3 1.00 T4 7.7 TSH 6.1 FASTING GLUCOSE 114 AND POST PRANDAL 126
Cervical spndylosis
Apart from this I would like to add my other symptoms in relation to cervical spondylosis.
Some times I get reeling if I bend my head down particularly if I read any thing while standing or answering a phone call. This was occurred twice or thrice in the last 16 years. This was there even in 1994 also. Sometimes neck pain and some times stiff neck.some times pain at the joint of the neck and shoulders. I have undergone MRI for cervical spine for spondylosis on 23rd Dec 2011
RADIOLOGIST IMPRESSION as on 23rd Dec 2011 (This was taken after the attack of first spell of vertigo.)
:
a)Early changes of cervical spondilosys with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level
Cervical lordosis is maintained.
Vertebral bodies appears normal in contour , body heights, alignment and signal intensity.
Marginal osteophytes are seen anteriorly and posteriorly from c2 to c6 levels.
No obvious spondylolistthesis seen
All cervical intervertebral discs are dark on T2WI with decreased disc heights-suggestive of changes of disc dessication
Contour of c2/3 adisc is normal
Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.
Early facetal arthropathy changes seen at all levels.
Anterior longitudinal and posterior longitudinal ligaments are normal.
Ligamentum flavum is normal
Cranio-vertebral junction is normalT1 hypootense, T1 STIR hypotense well defined vertically oriented lesionof size 3.2x3.3.x11.1 mm (APxTRxCC) is seen centrally within the cord substances at C4/5 , c5 levels
Pre and paravertebral soft tissues appear normal .
Namaste. I am hereunder giving detailed information for your perusal and kind and valuable advise in the matter.
ANSWERS TO YOUR QUERIES
1.Do you have head ache in association with these symptoms?
No. not at all.
2.Have you ever been on medication for tuberculosis or any medication on long duration
I never on medication for tuberculosis. But the following medicines are being taken
Had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then
Had mild Hypertension in the year 1980 (under control)
Had prediabetes in the year 2010 (IFG) (under control)
Had subclinical hypothyroidsm in 2011
Medicines now being used
Heart * (from the year 1977)
STAMLO BETA 50 MG Stamlobeta 50 mg since 2006
ISMO 10 MG One tab Twice a day since 1996
Tg Tor 50 MG One tab Once a day after dinner since
1996
ASA 50 MG One tab a day after dinner
since 1991
Type II diabets
GLYCOMET 250 MG One tablet in the morning since 10 days (previously half tab in the morning in the morning and half tablet in the night )since 2010)
Sub clinical Hypothyroidism
THYRONORM 75 MCG One tab once a day since july 2011
3.Please tell me if you are suffering from diabetes or hypertension?
I had prediabetes from the year 2010 and mild hypertension from 1980, but it was well under control.
4..The duration of the episode of vertigo you experience.Any association with vomiting?
On both the occassions, it was severe for a day or two, but later on became mild. No vomiting. But in the second spell I felt nausea for a few seconds along with spinning of the room.
5.Can you send the images of your audiogram and tympanogram?
Attached photographs of the both separately
comments of audiologist:
(Right ear)SISI Non significant Tone decay Negativescan ABLB satifactory
(left ear) SISI Non significant ABLB ---TONE DECAY Negative scan.
Provisioonal diagnosis: Right: borderline hearing with high frequency SN dip
LEFT : Moderately severe damage. mixed hearing loss
6.Any history of recurrent nose block or nasal discharge or nose bleed?
No nose block or no nasal discharge or nose bleed experienced at any time
7.Any family history of similar illness in your siblings or your parents?
None had this in my family
8.Have you undergone thyroid function tests?
Yes I had hypthyroidsm in July 2011. TSH is is little bit HIGH (10) previously. T3 and t4 are normal.enclosed the result.
TEST REPORT DATED29/2/2012
T3 1.00 T4 7.7 TSH 6.1 FASTING GLUCOSE 114 AND POST PRANDAL 126
Cervical spndylosis
Apart from this I would like to add my other symptoms in relation to cervical spondylosis.
Some times I get reeling if I bend my head down particularly if I read any thing while standing or answering a phone call. This was occurred twice or thrice in the last 16 years. This was there even in 1994 also. Sometimes neck pain and some times stiff neck.some times pain at the joint of the neck and shoulders. I have undergone MRI for cervical spine for spondylosis on 23rd Dec 2011
RADIOLOGIST IMPRESSION as on 23rd Dec 2011 (This was taken after the attack of first spell of vertigo.)
:
a)Early changes of cervical spondilosys with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level
Cervical lordosis is maintained.
Vertebral bodies appears normal in contour , body heights, alignment and signal intensity.
Marginal osteophytes are seen anteriorly and posteriorly from c2 to c6 levels.
No obvious spondylolistthesis seen
All cervical intervertebral discs are dark on T2WI with decreased disc heights-suggestive of changes of disc dessication
Contour of c2/3 adisc is normal
Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.
Early facetal arthropathy changes seen at all levels.
Anterior longitudinal and posterior longitudinal ligaments are normal.
Ligamentum flavum is normal
Cranio-vertebral junction is normalT1 hypootense, T1 STIR hypotense well defined vertically oriented lesionof size 3.2x3.3.x11.1 mm (APxTRxCC) is seen centrally within the cord substances at C4/5 , c5 levels
Pre and paravertebral soft tissues appear normal .
Dear XXXXXXX
Thanks for your input. After going through your complaint and investigation reports I would like to summarize first.
You have a problem of deafness, ringing sensation in ear and dizziness. The dizziness is episodic (comes and goes) and at times associated with nausea
There is a history of Diabetes, High blood Pressure and subclinical hypothyroidism. You also have problem of stiff neck. MRI showed early cervical spondylosis
Pure tone audiometry showed hearing loss of about 65 percent in one ear and 25 percent in another ear.
Tympanometry showed hypercompliant tympanic membrane and ossicles . This actually rules out problem of the ventilation in middle ear
My impression is
It appears to be the disease of inner ear called as Meniere’s disease which is characterized by sensorineural deafness, tinnitus and episodic vertigo associated with nausea and vomiting. At times patient may notice aural fullness before the episode of vertigo.
The inner ear has a function of hearing and balance. In Meniere’s disease, there is excessive secretion of fluid in the organ of balance which leads to increase in size of the organ of balance. This causes vertigo. As the organ of hearing and balance are in a thick bone ,the increase in size of the organ of balance causes pressure on organ of hearing causing hearing loss . Degenerating nerve fibers causes tinnitus.
Your problem of cervical spondylosis can also be attributed to dizziness but we cannot explain hearing loss and tinnitus because of cervical spondylosis
The answers to your questions are as follows
1. what are the other effective medicines in curing vertigo?
I would advise you to consult ENT surgeon before taking any medication for vertigo. Cinnarazine is a good choice. But it causes sedation and driving is not advisable if you are on this medication
2.Do i have to take vertin as maintenance dose say 8 mg or 16 mg once day for the rest of my life to prevent vertigo?
No. As the disease has a long course it is better to start it when you have fullness in ear and vertigo
3. what are the precautions i have to take when i go into the cold weather and travelling in an a/c compartment.
You should have your medication for dizziness. Avoid going alone. If you feel you had a bad experience in past with cold exposure. Avoid sudden changes in temperature around you
4. Can i take cold ice water for drinking?
Yes I don’t think this will cause problem unless you have allergy problem
5.does this vertigo is a combination of middle ear problem and also cervical spondylosis?
It is a combination of inner ear problem (80%) and may be attributed to cervical spondylosis(20%)
6. If so do i have to take stugeron along with the vertin
Yes you can combine both the drugs
7. If so what is the dosage.
Since these are prescription drugs, I would suggest you see an ENT surgeon in person to get this treated. You can start with a lower dose of Cinnarazine and dose can be increased if the patient is not responding to low dose. Vertin can also be given
8. How to differentiate the vertigo from spondylosis or from the middle ear problem ?.
In your case it is difficult to differentiate as you have both the problems
Ear disease causing vertigo – may have ear discharge, hearing loss and tinnitus and vomiting
Spondylosis causing vertigo – may have stiff neck, difficulty in moving neck, pain in neck
9.Can the vertigo be cured permanently or do i have to live with it for the rest of my life? 10.Do i have to keep Vertin always handy
I would advise you to consult in ENT department of a big hospital where they have a good audiovestibulometry back up. There are surgical options to relieve vertigo but I will not advise you for it because of your age, high blood pressure and diabetes. It is appropriate to consider medical treatment and salt restricted diet.
Possible diagnosis on the basis of information provided -
I will keep the diagnosis as Meniere’s disease with cervical spondylosis. To answers your questions
Keep your blood pressure under control. Keep your diabetes under control .Please consult a endocrinologist for you thyroid problem and diabetes . LOW SALT DIET is advisable
I hope this answers your concern. Do let me know if I can help you further
with warm regards
Ravinder Sharma
Thanks for your input. After going through your complaint and investigation reports I would like to summarize first.
You have a problem of deafness, ringing sensation in ear and dizziness. The dizziness is episodic (comes and goes) and at times associated with nausea
There is a history of Diabetes, High blood Pressure and subclinical hypothyroidism. You also have problem of stiff neck. MRI showed early cervical spondylosis
Pure tone audiometry showed hearing loss of about 65 percent in one ear and 25 percent in another ear.
Tympanometry showed hypercompliant tympanic membrane and ossicles . This actually rules out problem of the ventilation in middle ear
My impression is
It appears to be the disease of inner ear called as Meniere’s disease which is characterized by sensorineural deafness, tinnitus and episodic vertigo associated with nausea and vomiting. At times patient may notice aural fullness before the episode of vertigo.
The inner ear has a function of hearing and balance. In Meniere’s disease, there is excessive secretion of fluid in the organ of balance which leads to increase in size of the organ of balance. This causes vertigo. As the organ of hearing and balance are in a thick bone ,the increase in size of the organ of balance causes pressure on organ of hearing causing hearing loss . Degenerating nerve fibers causes tinnitus.
Your problem of cervical spondylosis can also be attributed to dizziness but we cannot explain hearing loss and tinnitus because of cervical spondylosis
The answers to your questions are as follows
1. what are the other effective medicines in curing vertigo?
I would advise you to consult ENT surgeon before taking any medication for vertigo. Cinnarazine is a good choice. But it causes sedation and driving is not advisable if you are on this medication
2.Do i have to take vertin as maintenance dose say 8 mg or 16 mg once day for the rest of my life to prevent vertigo?
No. As the disease has a long course it is better to start it when you have fullness in ear and vertigo
3. what are the precautions i have to take when i go into the cold weather and travelling in an a/c compartment.
You should have your medication for dizziness. Avoid going alone. If you feel you had a bad experience in past with cold exposure. Avoid sudden changes in temperature around you
4. Can i take cold ice water for drinking?
Yes I don’t think this will cause problem unless you have allergy problem
5.does this vertigo is a combination of middle ear problem and also cervical spondylosis?
It is a combination of inner ear problem (80%) and may be attributed to cervical spondylosis(20%)
6. If so do i have to take stugeron along with the vertin
Yes you can combine both the drugs
7. If so what is the dosage.
Since these are prescription drugs, I would suggest you see an ENT surgeon in person to get this treated. You can start with a lower dose of Cinnarazine and dose can be increased if the patient is not responding to low dose. Vertin can also be given
8. How to differentiate the vertigo from spondylosis or from the middle ear problem ?.
In your case it is difficult to differentiate as you have both the problems
Ear disease causing vertigo – may have ear discharge, hearing loss and tinnitus and vomiting
Spondylosis causing vertigo – may have stiff neck, difficulty in moving neck, pain in neck
9.Can the vertigo be cured permanently or do i have to live with it for the rest of my life? 10.Do i have to keep Vertin always handy
I would advise you to consult in ENT department of a big hospital where they have a good audiovestibulometry back up. There are surgical options to relieve vertigo but I will not advise you for it because of your age, high blood pressure and diabetes. It is appropriate to consider medical treatment and salt restricted diet.
Possible diagnosis on the basis of information provided -
I will keep the diagnosis as Meniere’s disease with cervical spondylosis. To answers your questions
Keep your blood pressure under control. Keep your diabetes under control .Please consult a endocrinologist for you thyroid problem and diabetes . LOW SALT DIET is advisable
I hope this answers your concern. Do let me know if I can help you further
with warm regards
Ravinder Sharma
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Answered by
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