Brief Answer:
Complete Vertigo assessment indicated

Detailed Answer:
Hi. Thank you for taking the time to write out a detailed account of your symptoms.
You seem to be having a lot of predisposing conditions that can lead to episodes of vertigo such as middle ear infections, eye strain or refractive errors, hypothyroidism or hyperthyroidism fluctuations, Type 1 DM, anxiety, stress etc.

Based on your history it appears as though the fluid collection within the middle ear due to eustachian tube dysfunction seems to be a clear precipitating factor. A viral infections is a strong possibility in view of recent viral infections. This explains your improvement with Nasonex. Even though this is self limiting, Nasonex should generally be used for a few months together to maintain benefits.

Also the fact that you feel comfortable when you lie down reduces the possibility of BPPV. A normal hearing test also rules out middle or inner ear pathology.

In my opinion you need the following evaluation for a complete vertigo assessment and It is recommended that you consult an ENT specialist for these

1. Dix Hallpike test
2. Contrast enhanced -High Resolution CT scan of the temporal bone (Bilateral)
3. MRI Brain
4. ENG/VNG

It will be great if you could share the results of these to help me manage your vertigo with more specific advice. I am uncertain why your PCP has not referred you to an ENT for a detailed assessment, but if it helps, please do discuss my recommendations for the same.

It is imperative that you need control of your blood sugars, thyroid levels, anxiety and stress to reduce the precipitation of vertigo.

For the time being I can recommend you to perform Vestibular Rehabilitation Exercises twice daily till a complete vertigo assessment is complete. These exercises are available easily online and will help your body adapt faster to triggers of vertigo and provide a longer remission to your symptoms.

Without knowing the results of the requested tests, I will not be in a position to identify a clear cause and advice management purely on basis of this history. It is possible in your case that there is more than one cause to the development of Vertigo. Please do share more information based on my advice to help me manage your vertigo more efficiently.

Hope this information helps. Your vertigo doesn't seem to be due to anything worrisome and I would advice a step wise approach to identify the cause and manage it appropriately. Do let me know if i can answer any further questions that you may have.

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Brief Answer:
Neurological cause unlikely

Detailed Answer:
Hi. Thank you for writing back.
It seems unlikely that your symptoms are due to a stroke or XXXXXXX stroke or a brain tumour, MS etc because your clinical history does not describe any focal neurological deficits or anything suggestive of transient ischemia or balance/gait disturbance or headaches and projectile vomiting.

Blurring of vision may be a neurological symptom but when in isolation may just be due to the nystagmus because of the vertigo. An MRI will rule any neurological involvement and is hence advised along with my previous recommendations.

Tingling sensation may also be a symptom related to nerves but in your case it appears that you developed severe anxiety due to the vertigo and anxiety is a common reason for tingling sensation around the lips. (next common cause is low calcium levels)

At the outset this looks like vertigo due to a preceding viral infection that has lead to an inner ear infection (Viral labyrinthitis) which can explain most of your symptoms. The middle ear fluid, type 1 DM ( since it slowly effects nerves to develop neuropathies), abnormal thyroid functions (slows reflexes in case of hypothyroidism and worsens anxiety in case of hyperthyroidism) and stress/anxiety are making you more susceptible to vertigo and hence the recurrences. However, without the tests that I have recommended, it is hard to conclude on the real etiology before initiating any targeted management.

Hope this helps. Do let me know if you have any further questions.

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