tinnitus Meniere's?

[nlualum82]

I was reading the thread about the IMO for Meniere's and it made me revisit the subject.

I have had balance problems, things "move", I suddenly bare down on the brake at a stoplight because I (wrongly) think my car is rolling...

I was tested befire I got out. The date on the electronystagmographic report is 10 Sept. '77.

My copy of the record has a graph covering some of the material, but one of the things I can see (but have little clue as to its importance) is "interpretation of caloric test" under which it says "symetrical response - with reversed fixation indicating a central pathology."

I remember I had to refrain from eating and drinking about a day before the test (most likely to keep their floor clean) and was not allowed to drive for several hours afterward.

I laid on a table and water was put in my ear. I could havwe sworn that I started spinning andsteadily gaining speed. electrodes glued all over me produced the graph through a big diagnostic computer.

Other clues are "postion testing: No induced nystagmus" and that the technician eadministering the test was a Sp 5.

I had thought of being retested while I was filing all my claims over a year ago., seeing if I had Meniere's or anything else.

I was at a C & P for otitis (which was pretty well documented but ended up being my only denied claim) with the most hostile examiner I've yet had(and he has a little competition) who drilled me about tinnitus even though I was scheduled to see him about the otitis and another examiner about the tinnitus.

On the way out of the room, I asked him if he would explain what this record indicated. He whipped it in front of him and right back, I believe he said "it means it's not their fault". I left it like that.

Any advice or suggestions?

Gary

Interestingly my tinnitus examiner cut me to ribbons in her report and it ended up being my biggest award, 10 % retro back to the day I after I got out in '78!

[Josephine]

I was reading the thread about the IMO for Meniere's and it made me revisit the subject.

I have had balance problems, things "move", I suddenly bare down on the brake at a stoplight because I (wrongly) think my car is rolling...

I was tested befire I got out. The

May I ask what were you experiencing for you to have this test? The famous Caloric Test?

You are stating that this test was preformed while you were still in service correct?

I may be just the person to help you.

Inner ear and Vestibular disease is far and between. I have had the condition since 1994. I am aware of all test and what you are experiencing, and perhaps, I can help you.

You may send me a personal message if you would like, or we can talk on the board.

This is from research on the internet- does this sound like You?

Symptoms and Incidence of Ménière's disease

Symptoms

Ménière's disease is usually characterized 4 symptoms.

1) Periodic episodes of rotatory vertigo or dizziness.

2) Fluctuating, progressive, low-frequency hearing loss

3) Tinnitus

4) A sensation of "fullness" or pressure in the ear.

Detailed description of symptoms

1) Periodic episodes of rotatory vertigo or dizziness.

Periodic attacks of vertigo ( the so-called Ménière's "attack") is the most disruptive of the symptoms to the patient. It is usually the vertigo attack which causes the patient to seek medical treatment. Typically, vertigo occurs in the form of a series of attacks over a period of weeks or months, interspersed by periods of remission of variable duration. The attack consists of a period of dizziness or vertigo (dizziness may include a feeling of unsteadiness; the term vertigo is normally reserved for the perception of spinning). The sensation of spinning may produce nystagmus (a beating of the eyes from side to side), nausea, vomiting, sweating and all the symptoms normally associated with extreme motion sickness. The onset of vertigo may be preceded by a sensation of fullness or pressure in the ear, increased hearing loss and tinnitus, as described below. The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. Unsteadiness may persist for the following hours or days.

Vertigo must be one of the worst chronic afflictions to affect the body. The vertigo patient perceives either that the world is spinning around them or that they themselves are spinning. With many other disabilities, some portion of a normal life can be continued. Vertigo disrupts virtually every aspect of life, since the patient loses the ability to do anything normally, especially when movement is involved. In addition to the obvious hazard of falling, moving around is hampered by the fact that even small head movements often make the spinning sensation worse. The resulting nausea, sweating and vomiting combine to make the patient subjectively very "ill". Vertigo can totally incapacitate the individual, so they cannot function. Often the patient will confine themselves to bed until the symptoms subside.

Most normal individuals probably cannot appreciate the devastating impact of this condition. Most of us are familiar with mild forms of vertigo or dizziness (from fair rides, excessive alcohol consumption, etc.). If you haven't recently experienced vertigo, try the following experiment (in a large open space, on a soft surface such as grass). Take hold of a heavy object at arms length (my son recommends a school backpack full of books) and spin around, leaning slightly backwards to balance the bag. Spin around 10-20 times at a rate of about 2 revolutions /second. Alternatively, if you don't want to injure yourself by falling over, sit in an "executive" swivel chair and have someone spin you around as fast as they can without the chair becoming unstable, for 20-30 seconds. In both these cases, you will experience rotatory vertigo for a few seconds when you stop rotating. You will have the sensation you are still spinning, your eyes will exhibit nystagmus (a beating from side to side) and if you continue, you may experience nausea. Based on this experience, you now partially understand the problem. There are additional factors which the patient must deal with. One is that their vertigo may last from hours to days, compared with the few seconds you experienced. With the brief episode you experienced, the vertigo declined quickly with time. For a patient, the vertigo may be sustained, or even increase in intensity over a few hours. Another difficulty the patient may have is that the vertigo can be made worse by "external" stimuli, such as head movements or loud sounds. Even TVs and radios may have to be avoided. It should also be considered that in this exercise, you had control over your situation and you knew you could stop when you wanted. You also knew that you would be fine tomorrow. The Meniere's patient has to deal with a lack of control of their situation, except for the limited control provided by taking anti-vertiginous drugs. Even when the symptoms have passed, they must face the stress and uncertainty of when the next episode will occur, and whether it will be more or less severe than previous ones. It is generally true that most people underestimate how disruptive episodic rotatory vertigo can be to an individual's life.

2) Fluctuating, progressive, low-frequency hearing loss

The hearing loss usually affects one ear, which typically loses sensitivity to low-frequency (bass) sounds the most. As well as being harder to hear, sounds may appear "tinny" or distorted. Loud sounds may cause more discomfort than normal (loudness intolerance). The hearing loss fluctuates over time. Sometimes the hearing may recover to some extent, but then on other days hearing may be difficult. In addition, the degree of hearing loss may get progressively worse with time, eventually affecting all sound frequencies and hearing may be completely lost in the affected ear.

3) Tinnitus

Tinnitus is sustained, loud "ringing" in the ears. Many normal individuals experience brief episodes of tinnitus, such as a loud "ping" which declines over a period of seconds to minutes. The tinnitus experienced by Ménière's patients is continual and does not abate with time, although its intensity may vary. The tinnitus is generally nonpulsatile. In addition, it may be heard more as a load roaring or buzzing sensation, rather than a whistling.

Aural fullness

The feeling of "fullness" in the ear is similar to that experienced by barometric pressure changes (such as when riding up or down a hill, or ascending or descending in an airplane). However, this fullness cannot cleared by swallowing, as in the case of pressure changes.

Incidence and Prevalence of Ménière's Disease

Incidence and prevalence are sometimes confused. Incidence is defined as the number of new cases in a population over a period of time; Prevalence is the number of existing cases in a population at a given point in time.

The incidence of Ménière's disease has been estimated to range from 0.5 to 7.5 per 1000, although this figure depends upon a number of factors, such as the diagnostic criteria used to define the disease. It also varies by ethnic background, showing relatively high incidence in Britain and Sweden. However, it affects not only the white race but also blacks and oriental races.

Ménière's disease most commonly affects people in their 40's and 50's, although individuals from 20 onwards may be affected, as in the picture below. It is rarely, though occasionally reported in children. Males and females appear to show a similar incidence of Ménière's, as shown in the graph.

Age Distribution of Ménière's

Natural Time Course of Ménière's Disease

The time course of the disease has been documented in patients who were suitable candidates for surgery, but who declined surgical treatment of their vertigo (Silverstein et al. 1989). Initially, the frequency of vertigo attacks in these patients varied from less than 3 to more than 10 per month. After two years, more than half the patients were vertigo-free and most of the remainder showed less than 3 attacks per month. After 8 years, the vast majority were vertigo-free, although a small number showed less than 3 attacks per month. This decline of symptoms with time was generally comparable to the group of patients who elected to undergo surgery, although the severity of the vertigo was not compared during the two year period following surgery. Also, although vertigo attacks may become less frequent over a number of years, the hearing loss tends to progress and tinnitus often remains a problem. Thus, it should not be concluded that spontaneous "recovery" from the disease occurs. There are also many patients (such as patient #4 below) in whom the symptoms do not abate, even after many years. There is tremendous variability in the long-term evolution of the disease.

Descriptions of symptoms by patients

For persons unfamiliar with Ménière's disease, these descriptions of symptoms make you realize how disruptive the disease can be.

Patient 1

Male, 3 year history of symptoms.

The worst symptom is the vertigo. In short, you feel like you go round and round then you throw up! However, it varies and I have had various manifestations. I can remember on several occasions where I would be sitting at a conference table in a meeting and the room would suddenly shift such that one end seemed "higher" than the other. In some cases I could work through it by squinting or finding something to focus on. In other cases I had to stop. The episodes generally passed within a few minutes. If they didn't generally Meclazine (antivert) would help.

Another manifestation is such that the "spins" would set in. If they were not too bad I could manage to walk to the water fountain to take a pill. Walking was generally difficult and I would use the wall to steady myself. During these times as I would take a step I would be unsure where the floor was. It always seemed quite a bit farther away than I thought.

Severe episodes would have the room start by shifting then begin spinning in a right to left direction. Trying to focus on an object sometimes helped. Generally the only thing to do was to try and sit or lay down in a quiet place and wait for it to pass. Meclazine would seem to help providing I got it down before the vomiting set in.

I found that if I moved my head and held it at certain angles that it would bring on the spins. Generally these subsided as soon as I put my head back in a "normal" position.

Loud noises and "busy" places were very annoying and tended to aggravate an attack.

I found that I might have days where I was experiencing mild vertigo. While annoying I was generally able to work/exist through them. I guess you just get used to it.

Patient 2

Male, Age 31, 8 year history of symptoms.

My perspective of Ménière's is like that of living with a time bomb that has a random number generator on the timer. You never know when its going to blow. As I understand it, the body loses control of the fluid regulation in the inner ear, then all hell breaks loose. I can usually tell when its going to happen, it is preceded by:

1. Fullness in the ear, popping like that you get when coming down from a mountain.

2. As the attack nears, my hearing gets worse.

3. Then my vision becomes like "tunnel vision"

4. I get very tired.

5. At peak, I sweat, throw up, sleep for 12+ hours .

6. The next day I feel as though someone beat me with a 2 by 4.

7. It takes two or three days to feel better.

Patient 3

Male, Age 46, 8 year history of symptoms.

I try and explain vertigo to people by telling them it is as if you drank a lot of alcohol and then rode an amusement park ride called the Tilt a Whirl. It's the closest thing I can use to describe what it feels like. The first time I experienced it, I was getting ready to go to a Denver Broncos game. I walked down the hallway in my house and ran into the walls five times in only a length of ten feet ! Went to the game anyway but I didn't have to drive and I certainly didn't drink. I had no clue what was wrong. I was very nauseated when I got home.

When I move my head from one side and stop in the the normal position, my eyes feel like they keep going to the other side of my head. I can't watch TV or even read a book. One time I decided to try and read a book but keep my head absolutely still. It didn't work.

The illness comes upon me with very little warning. Once, I was driving back from Arkansas with my wife. I felt kind of light headed. I got out of the car and started to the restroom and within three steps I knew it was all over (the vertigo attack started). I had no medicine so I took large doses of Dramamine and slept pretty much the next two days till we arrived at home. I now carry meclazine with me in my wallet. I also coach high school football. This last fall I had to ask another coach to take over for me because I knew I wouldn't be able to stand on the sideline. Sometime it only acts up for a day other times it goes for 5-7 days.

Patient 4

Female, Age 32, 22 year history of symptoms.

Life with Meniere's Disease : Before you judge me on one of my good days, you need to understand what one of my bad days is like.

Tinnitus - imagine having a headache caused by a fire alarm ringing or a bee buzzing in your ear continually for a long period of time. You can't hear anything but that fire alarm or bee - It drowns everything else out.

Vertigo - Now imagine yourself as really drunk or with the flu at the same time as the fire alarm is going off. Now imagine that with these two things, you'd be dumb enough to get on one of the super roller coasters that does loop-de-loops or the amusement park rides that spin in two different directions at the same time. I'm not that dumb, but unfortunately I have no choice in feeling these sensations.

During one of these vertigo attacks that can last from several minutes to several hours if not days. I can't keep food or water down, I can't walk, and in order to get out of bed to go to the bathroom, I have to crawl like a baby on my hands and knees. The movement makes me so ill, if I'm able to crawl back to bed, I'm covered in sweat from exhaustion. Otherwise, I keep a pillow and a blanket at the bottom of a linen closet in the bathroom so that I can pass out lying across the bathroom floor. I end up sleeping for days after one of these attacks, only getting out of bed to go to the bathroom or to get something to drink, if I think I can keep it down. I have to call my family to see what day it is when I wake up. That is, if I can hear.

You see, this disease while playing havoc with your balance and equilibrium, also reeks havoc with your hearing. It wouldn't be so bad if the hearing loss was constant and predictable. But no, one day I can hear conversation fairly OK, and the next I can be virtually deaf, then the next day I can hear again. The hearing loss can fluctuate, but is usually progressive, and many with the disease end up severely hard-of-hearing or deaf.

Even on a daily basis, your mind is so confused by the signals its getting from your ears that your balance sucks. You run into things constantly because you can't balance well enough to avoid walking into things, or your mind is telling you the object is a couple of inches from where it really is. I don't know whether to laugh or cry when someone teases me about being such a klutz. I could make the Keystone Cops look graceful.

I also have days that my coordination just doesn't seem to be together. I'm carrying something, and all of the sudden I drop it because my brain seems confused as to whether my hand is really attached to my body. I sometimes miss a step and fall because of the feeling that my legs are not quite part of me and I have to focus on them to realize they are there.

Apparently this happens because the part of your brain that recognizes parts of your body as belonging to you is the parietal brain lobe and it sits right above your ear, so if the nerves around your ear are inflamed, it can press on this part of the brain, or send the wrong signals to it (I'm not quite sure which), and you can lose coordination.

Ironically, the few high frequencies I don't seem to have a hearing loss in can sound extremely loud, unbearably so. When a baby cries, an alarm goes off, or a microphone gives off feedback, I'd be willing to climb up a wall to get away if I thought I could make it. This symptom is called recruitment.

The disease also plays tricks on your vision. For some strange reason, the nerve that goes from your inner ear to your brain also controls some of your eye movement. Your eyes can twitch or bounce constantly, making focusing on objects, much less print, extremely difficult at times. Your eyes tend not to be able to "track" movement at the same speed, giving you double vision, and a bad headache.

You can get confused easily and your memory and concentration aren't reliable. It's what some people with the disease refer to as "brain fog". Many of them originally were afraid that they may have a brain tumor or Alzheimer's because it can sometimes gets so bad. Finally they find either a doctor whose very knowledgeable regarding the symptoms, or they happen to ask someone else with the disease, and find that this too is a symptom of this blasted disease.

Now try to imagine living with this disease never knowing when one of these periods of tinnitus, vertigo, hearing loss, double vision, lack of coordination, recruitment, disequilibrium, or "brain fog" is going to hit, or how bad it will be. At least with being drunk or riding an amusement park ride, you know what's causing it, and you can make the choice not to do it again. With this disease, there's very little warning if any for these attacks, you don't know what's causing it, and there's no cure - only devices, surgeries, and some medications that can somewhat help alleviate the symptoms. And some of the surgeries are so radical, you think they came from a horror movie about a mad doctor. My ENT surgeon won't even perform any more surgery on my left side, since I have the disease in both ears. He's concerned about what would happen if my right side became worse than what my left side is now.

Understandably, anxiety and depression seem to go hand-in-hand with Meniere's for many sufferers. We often ask how much worse can this disease get? For some strange reason, doctors aren't very willing to give out worst case scenarios.

Now decide if you think I'd be able to do the same things you do on as punctual and regular of a schedule. For me, there's no way. I'm being up front about my limitations. I try the best I can at living up to my full potential. Could if you were in my shoes? They think now that Van Gogh suffered from this disease, and he cut off his own ear trying to escape it.

Yet on my not-so-bad days I may look like a totally healthy, able-bodied person. You ask me "why can't you bend down - pick it up - lift it - drive - get a job - walk without a cane" Its because I know these things can either bring on an attack - I couldn't do them on a regular schedule because of the symptoms - or if I did do them, I could put myself and others in jeopardy if I should have an attack. You have to realize that with my friendship, love, dedication, and loyalty comes the fact that I can't decide when I'm going to have a bad day, and the more stress I'm under, the more likely I will have a bad day.

So, please don't judge me unless you've been in my shoes."

Josephine

Edited October 27, 2006 by Josephine

[timetowinarace]

"symetrical response - with reversed fixation indicating a central pathology."

This phrase does not indicate a inner ear problem. It's saying that vertigo IS present but a central pathology means it is caused by the brain. Central means brain. Meniere's is an inner ear problem.

I have had the testing for my dizziness/vertigo. The tester was very surprised that I didn't feel nausious or like I was falling and that I recovered very fast (could focus on a dot). He decided that I was dizzy so often that I was used to it. Anyway, the testing found no sensory problems and central dizzyness/vertigo was the conclusion.

Many things can cause central vertigo. Head injury (even a mild cuncusion), meds, major depression, seizure, cognative dissorder (slow proccessing speed), ect.

Without new testing and a definate diagnoses this report will make it hard to be SC for meniere's. The good part is that if you can get a diagnoses for the vertigo, the test proves you had it in service.

That is my VERY non-expert thought though.

Time

[nlualum82]

Sounds something like me. I have learned to deal with the dizziness. I had the caloric test while in service and my records show I complained of balance problems.

I can be nauseous from it, but am not day to day. I don't know how fast my recovery time would be rated, but being spun around or dioriented for a short while can make my head feel bad all day.

I was tested in service and found to have a hearing loss, which has increased over the years. I have records back to before release that show complaints of tinnitus.

My ratings now include 50% for bilateral hearing loss

10% for tinnitus

70% for PTSD/MDD

I also have a couple of 10% ratings for my left knee, injured in a jeep rollover (I was the passenger, thrown waaaay out) and the degenerative osteoarthritis of it.

Is vertigo itself rateable? would it be combined or would they rate the greater of that and my hearing loss? - the hearing loss wins hands down!

When I went to night shift a few years ago I started drinking coffee to get used to being up all night. I had to give it up because the dizziness increased quite noticeably.

While they don't seem to separate it, I feel that my PTSD/MDD problem could be at least as much "depression secondary to hearing loss as my documented PTSD stressors.

I got my rating fast and on the first try because my stressors were well documented - UCMJ court martial proceedings of a fellow soldier who held a group of us hostage and the medical records from the jeep wreck. The C & P made it obvious to the rater that I was an "odd bird" after 28 years of increasing isolation, etc.

It is time to NOD my denial for a 10% rating for "6210, chronic otitis externa", well documented by VA and HMO Drs. but the only denial I've ever had!

Gary