
What Causes Recurring Episodes Of Hearing Loss With Dizziness, Tinnitus And Migraine?

This past year I had 3 reoccurring episodes of "sudden hearing loss" with no vertigo in my right ear. The first time I had it, I just woke up with it. I went to an ENT, and I got a hearing test done, and some other tests as well, and it showed no measured hearing loss in the normal ranges, and that my nerves were fine. While indeed I didn't go deaf, but my hearing did feel muffled, and my ear felt like it as clogged. ENT didn't see any thing physically wrong with it, and called it idiopathic SSNHL. Gave me prednisone which I responded well to, hearing went back to normal in 3 or so days. 7 months later I had another episode (same symptoms), so I went to the ENT again. This time I didn't get any test done, and was prescribed Prednisone again. In about a day, my hearing came back and everything felt normal. 4 months later, which was last month, I had it again. But this time it was a little different. I didn't really noticed it until an hour later I woke up from a nap.
I went to an ENT (a different one from my first 2 episodes, due to location) the next day, and he said he didn't see any infections and what not. He told me I might have Cochlear Hydrops or Meniere's, and put me on prednisone. However while on prednisone, my symptoms didn't improve, but rather I developed a severe tinnitus. I went to get an audiogram, some 5 days later, but they didn't measure anything strange other than a particular frequency in the mid ranges being lower than rest. That very same day, my hearing and T got worse, and I started to hear distortions. At the same time I was also on a higher dosage of prednisone. A few days later I had a day where my Tinnitus died down to almost nothing, and my hearing felt almost fine again, but about 24 hours later it reverted. While I felt like the prednisone wasn't working, I forced tapered, and after I was done tapering, my hearing came back again, and it's been that way for some 3 weeks now. However I still have a very mild tinnitus in my ear (I can hear it usually in a relatively quiet environment, it's like there are 3 sounds, 2 beeping ones with different pitch, and a ringing), but the sound is very different from my severe tinnitus (buzzing). Also it should be noted 2 days prior to my current recovery, I did have a massive migraine, but there was no vertigo or dizziness, although I did feel nauseous. I credited as withdrawal from prednisone since I quickly dropped the dosage for a force taper. This episode lasted about 2 weeks.
So here is the deal, while I still don't know what really caused my problems however, the idea that my previous ENT told me that I might have meniere's really hit me hard, since I had 3 episodes of supposed SSHL. As mentioned before I didn't have vertigo during the hearing loss episodes. But in between the 2nd and 3rd episode there was a time I had a bit of dizziness for a night, but I had no hearing loss or tinnitus during that, and it was really mild. But this was at about 2 months before my 3rd episode.
Anyways, do I really have meniere's disease or did my ENT only say that because he had no idea what is going on? I am actually anxious, and scared recently because my last episode really traumatized me, since I know meniere's is a progressive degenerative disease that, if I have it, might put me into a state similar to my last episode of SSHL. And also can a non-noise induced tinnitus get worse after riding an airplane for some 6 hours?
Temporary Threshold Shift (TTS). Meniere's or Vestibular Migraine possible.
Detailed Answer:
Hi,
Thank you for your query.
1. The first two episodes were Temporary Threshold Shifts (TTS) in Hearing. If these occurred after noise exposure, they can be named as Noise Induced Hearing Loss (NIHL) or ISSNHL.
2. The third episode does bring to mind the possibility of Meniere's Disease and Migraine associated Vertigo (MAV). There are cases of Meniere's with migraine.
3. 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, the hearing usually worsens during an attack and the tinnitus also worsens.
Early Meniere's disease usually causes low frequency hearing loss initially ( Audiogram sloping to left).
Meniere's disease should normally respond to a salt restricted diet, acetazolamide (Diamox) and betahistine (Vertin). High dose betahistine is a new approach.
Meniere's Disease develops gradually but it may burn out and many people do not develop further episodes. It usually occurs after 30-50 years of age, while your age is 22 years.
4. Migraine Associated Vertigo (MAV) responds to anti-migraine medication.
5. The exact cause of Tinnitus is unknown. However one of the the agreed pathologies is damage to or loss of to hair cells in the inner ear. The role of the brain in the perception of Tinnitus also exists. For example, some people have been relieved of Tinnitus after a cerebral stroke, while some continue to hear it even after the Cochlear (Hearing) Nerve is cut. In most cases it has no clinical significance.
6. What is your exposure to occupational noise and loud music / earphones / XXXXXXX phones? Exposure to loud noise is also a leading cause for tinnitus.
7. If your Tinnitus increases on clenching the teeth, it may require dental bite correction.
8. I have noticed patients who have increased Tinnitus when they are stressed, have fluctuations of blood pressure, low hemoglobin, low blood sugar levels and so on.
9. Cochlear Synaptic Tinnitus may be treated in up to 50% people with Caroverine infusion followed by capsules for two months. Other treatments such as trans-tympanic steroids, gingko biloba, multi-vitamins and anti-oxidants may also help in reducing Tinnitus.
10. Tinnitus may increase after a long flight but this would be related to middle ear pressures.
11. Upload an Pure Tone Audiograms (PTA)s and Impedance Audiograms that you may have done along with a current set of tests.
12. I must emphasize that in a vast majority of patients of tinnitus, the cause is never found. However there are further treatment options depending on the type of tinnitus.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.


However the audiologist reported Findings as: "Pure-tone test results indicate essentially normal hearing sensitivity, with a mild hearing loss at 8000 hz, left ear, and a mild low frequency sensorineural hearing loss, risng to normal hearing sensitvity, right ear. Speech recognition ability in quiet was excellent, bilaterally, when speech was presented at an average conversational level"
As for the typical meniere's symptoms. I had no vertigo associated with onset of SSNHL. Tinnitus gradually got worse the longer I was on higher dosage of prednisone, however aforementioned, my perceived hearing loss seemed to return to baseline, with tinnitus changing to something else (much more quiet, and different pitch). As you said it might be an early form of meniere's which is why I am anxious.
Anyways, thanks for the feedback, I only wanted an opinion of another ENT to see what illness plagues me. If I do have meniere's, I hope I would go on a remission for the next 2 decades starting now, at least by then there might be proper treatments to reduce the worse of the disease.
You can take proactive steps.
Detailed Answer:
Hi,
Thank you for your query.
1. In the audiogram that you have described, the 8 kHz dip is an NIHL. The mild low frequency hearing loss is consistent with early Meniere's Disease (or endolymphatic hydrops). A normal Speech Discrimination Score (SDS) indicates a cochlear problem (as against a retro-cochlear problem).
2. You should take a trial with a salt restricted diet, acetazolamide (Diamox) and betahistine (Vertin).
3. The possibility of Autoimmune Inner Ear Disease (AIED) which mimics Meniere's Disease should be kept in mind and investigated accordingly.
4. Electrocochleography (ECochG/ ECOG) will be a useful investigation in your case to confirm or rule out Meniere's Disease.
5. Hence you can work towards a reduction in the progress of the endolymphatic hydrops rather than wait for a spontaneous remission.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.


As for medication goes, I have yet to have vertigo attacks, so I don't think I need betahistine at the moment. I did lower my salt intake considerably as well.
I also take a blend of vitamins, and gingko biloba supplements. I just hope due to my young age the disease itself goes into spontaneous remission for a while after changing these factors.
Regards.
Betahistine has other indications in addition.
Detailed Answer:
Hi,
Thank you for writing back.
1. Do not discount the betahistine as yet. Let your doctor decide. It can be used in sub-clinical 'classic' Meniere's or 'cochlear' Meniere's Disease. It can be used to treat tinnitus. It is a safe, well tolerated medication.
2. Yes, it is good that you are taking nutritional supplements to boost up your immunity.
I hope I have answered your query. Please reply back with the answers and I will be able to help you further.
Regards.


Food allergy is implicated but not proven.
Detailed Answer:
Hi,
Thank you for writing back.
1. The cause of Meniere's Disease is unknown. These are theories and multiple factors may be involved.
2. In the initial stages, anti-viral, steroids, anti-migraine treatment anti-allergic treatment should be tried, and in your case, food intolerance tests can also be done.
3. Electrolyte disturbances are most likely to be one of the main underlying causes. Salt restriction helps, but newer theories suggest that it may not be required.
4. The progress and natural history of the condition remains unpredictable.
I hope I have answered your query. Please reply back with the answers and I will be able to help you further.
Regards.

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