I can't walk straight or hear over the ringing.

May 23, 2012 10:35 PM

I've been experiencing some troubling symptoms with increasing frequency and severity, namely vertigo and tinnitus. They're affecting daily life to such an extent that I know something needs to be done. What kind of doctor should I visit, and can these symptoms be alleviated in the meantime?

Occasionally, I'll be reading or otherwise going about my daily life only to be struck with sudden vertigo. Everything is spinning and I can't walk in a straight line when this happens. It's exacerbated by tilting my head. It's happened while I was driving once, but subsided just before I was about to pull over.

The vertigo always coincides with the times when my left ear is ringing (always the left ear) and has been for a few days. The sound is deafening, remains at one frequency, and is constant for days on end. This happens a couple of times a month, but used to be more rare. I can't hear well with the left ear when this happens, and what I do hear is kind of muffled or garbled. Music sounds off-key.

Basic health stuff: blood pressure, weight, etc are fine. I get plenty of water and sleep. I'm 20 and female. I wear a mouth guard at night for TMJ problems, but haven't had any troubles with that lately. I take Aleve for a few days (2 pills a day) each month for menstrual cramps, but don't take anything else on a regular basis.

The constant ringing is very distracting and I'm tired of asking people to repeat everything they say. Even worse, I'm concerned about getting vertigo while driving again. I regularly drive 1-2 hours and want to do so as safely as possible.

So, GP or a specialist? What can I do to fix this?

posted by cp311 to health & fitness (19 answers total)

I'm no doctor, but it could be Meniere's disease. You should see an ENT doctor, not a GP.
posted by MaryDellamorte at 10:41 PM on May 23, 2012 [1 favorite]

go see your gp (or, on preview, even better go to the ENT guy), if you trust her or him, and get a rec to an audiologist or neurologist. go in there planning to get a second opinion, so if you don't have to, it'll be a bonus.
posted by facetious at 10:51 PM on May 23, 2012

Get checked out for labrynthitis. It can be viral; i got it from sharing a work phone with someone who had it.
posted by esmerelda_jenkins at 10:54 PM on May 23, 2012 [2 favorites]

A person referred to as Dr. Neil of Hearing Loss Help says Aleve can cause tinnitus and hearing loss:

The bad news is that Naproxen (Aleve) is known to cause both hearing loss and tinnitus (and a bunch of other ototoxic side effects as well). In fact the “official” figures (which I think are much too low) indicate that Naproxen causes hearing disorders in up to 3% of the people taking it, and tinnitus in up to 9% of the people taking it. It looks like you are one of the “fortunate few”.

posted by jamjam at 11:51 PM on May 23, 2012

I was here to comment on migraine-associated vertigo, but when I went to find a nice online source to discuss it, the page at the Mayo Clinic I found discusses one cause of exactly that,

"Acoustic neuroma. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma generally include progressive hearing loss and tinnitus on one side accompanied by dizziness or imbalance."

posted by sciencegeek at 1:50 AM on May 24, 2012

Seconding ENT as a good starting place.
posted by Daddy-O at 2:24 AM on May 24, 2012

My guess would be Meniere's disease. But IANAD and the number and variety of guesses here should make it clear: go see the otolaryngologist as soon as you reasonably can to get some definitive information.

Good luck.
posted by wjm at 2:55 AM on May 24, 2012

ENT, CT scan, rule out cancer or meniere's first but this could well be an occult sinus infection, which caused very similar symptoms for me once. Not something to fool with, by the way. By the time mine was properly diagnosed I needed yucky surgery to get it out of there.
posted by spitbull at 4:47 AM on May 24, 2012

You need a MRI to rule out an acoustic neuroma. I have family that had an acoustic neuroma. You don't want to let that linger. It could be Meniere's, but Meniere's is not really that common. I was mis-diagnosed with it years ago. Go straight to the ENT.
posted by COD at 5:18 AM on May 24, 2012

Sorry, I realized that I didn't actually answer your question. Yes, you should go to an ENT; GPs have always been crap for my ear stuff. As to alleviating your symptoms in the interim, try taking an antihistamine with pseudoephedrine in it (Clairitin D). I got a prescription for Clairitin D when I had a fluid imbalance in my ear, and it worked very wel; I believe it has gone OTC since then. If you can't find that, straight pseudoephedrine helps too.
posted by esmerelda_jenkins at 5:37 AM on May 24, 2012

You're not supposed to 'guess' what type of doctor you need to go for ANY ailment. You're supposed to go to your primary care physician (who is likely a general practitioner) and he or she will make the determination as to whether you need to see a specialist, what kind of specialist, and they will recommend some specialists they have worked with in the past and trust.

Besides the fact that this is what the vast majority of insurance companies require, it also just makes sense. If you don't have a PCP, well, you should.
posted by imagineerit at 6:54 AM on May 24, 2012

I've had tinnitus for many years - and went the whole medical route, with endless amount of tests and in the end only got a shrug and "nothing we can do".
I find that varying over the counter medications make the tinnitus unbearably worse (ASA, Aleve, cold remedies) and some herbal remedies (St Johns Wort).
My understanding tinnitus is constant and permanent. I believe I got mine from antibiotics - which tinnitus can be a side effect. Although it may quieten down at times or roar up - it never goes away.
I would track the times and days that your ear is ringing and see of there is a pattern and connection to something else. Look at diet, OTC's, medications, electronics and other health issues.
There is ‘white noise’ hearing aids that are suppose to help and there is a biofeedback therapy thing you can do (that supposedly helps). I just cope by have ear plugs in tuned to a talk radio station or music. I always have to have some kind of distracting noise around me - to drown out the ringing.
I've had the vertigo thing on and off - Dr's usually say it's a sinus thing and refer to an OTC that makes the tinnitus worse (*sigh*). But get it checked out.
posted by what's her name at 7:04 AM on May 24, 2012

Please see your family doctor/PCP first, and ask for a referral to an ENT. That way your doctor will have a record of your symptoms (should they crop up again, or be indicators of something unconnected to ear issues) and you will have a referral in hand to go see someone who specializes in cases where vertigo and tinnitus are common symptoms of ear-related issues.

FWIW, it's my understanding that these are both symptoms of Meniere's, as mentioned above.

I think you'll get *best* results from an ENT visit. But your regular family doc/PCP should be made aware of what's going on with your health.
posted by MonkeyToes at 8:05 AM on May 24, 2012

The ENT can (and should) send a report to your GP. It's standard practice. Unless you have an HMO that requires a referral to a specialist, there is no reason to waste an appointment at the GP when it's 99% likely that you need to see the ENT.
posted by COD at 8:40 AM on May 24, 2012

You're awfully young for Meniere's disease... so that may not be what's happening here. If you do have a good relationship with a primary care doctor, I'd start there. If not, start with an ENT.
Some things you should try to quantify/explain for the doctor:
* How long does the vertigo last? (A few minutes? An hour?)
* Does anything in particular bring it on? Anything make it go away?
* Do you have any hearing loss?
* Any sinus/cold symptoms?
* Any vertigo or dizziness apart from these episodes that are linked to the tinnitus?
* Any feeling of fullness in the ear? Any pain? For how long?
* Any link to headaches/migraines?

IANAD, just someone who's been dealing with this stuff for a while. The more precisely you describe the symptoms, the better the odds of getting a correct diagnosis.
posted by tuesdayschild at 8:47 AM on May 24, 2012

Meniere's isn't, so far as I am aware, strongly correlated with age. A 25 year old is about as likely to have it as a 50 year old. I have no idea if this is Meniere's but I don't think her age makes much of a difference in the probability.

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posted by Justinian at 2:16 PM on May 24, 2012

As a lot of other people have said, you need to get an MRI. You could have a Chiari Malformation, which is a condition where your cerebellum is too big for the bone pocket it sits it. This blocks the flow of your cerebro spinal fluid, and can lead to all kinds of unpleasant effects, both short-term and long-term. My wife had this - surgery to correct was 18 months ago and she has fully recovered; all her symptoms are gone.
posted by Irontom at 5:24 AM on May 25, 2012

I find my tinnitus is strongly affected by caffeine and alcohol. You might want to try cutting out all coffee (even decaf), tea (herbal teas are OK, but no black or green or white tea), colas (including "decaf") chocolate, and alcohol, and see if this helps your tinnitus. I found it helped tremendously.

The other thing that really helps me is chiropractic care. Your TMJ may also be helped by a good chiro.

However, given all the other conditions people have listed above, I'd get an OK from a GP to get chiropractic care before going, as there are some chiros who won't properly refuse to adjust you if you have a spinal problem they could make worse, so you should be seen by a GP first. If you can, try to find a chiro who does "Gonstead" treatments. They are chiros who have additional training, and who use a much more specific adjustment protocol, only adjusting specific places rather than cracking your whole spine. However, there aren't a lot of Gonstead chiros, they tend to be both busy and expensive (because they are GOOD!), and your insurance may not cover their costs.
posted by jcdill at 9:18 AM on May 30, 2012

An update: I had an appointment with the GP last Tuesday and was given Antivert and Sudafed for the symptoms, until I see the ENT doctor later this month.

The doctor thinks something may be blocking the Eustachian tube, hence the Sudafed to drain everything, but my symptoms haven't subsided at all. On the contrary, my ear has been ringing constantly and deafeningly since Wednesday. I've had a little vertigo, but it was milder and didn't last long, likely due to the Antivert.

The ENT doctor will do vestibular testing and hearing tests when I go. Are follow-up appointments common? I'll be taking classes out of town for the duration of July, but I can come back in the afternoon for appointments if needed (~1 hour drive).
posted by cp311 at 11:26 AM on June 4, 2012