DangrusDave
Guest
For my first post, I have decided to give the docs a brain teaser. I have a vestibular problem that may be diving related, but my doctors have been unable to pinpoint the reason and fix it yet. Any advice on things I should discuss with my doctors would be greatly appreciated. Here is the timeline of symptoms and treatments to date:
During flight school had stretched Eustachian Tube in my right ear, continuous pressure in right ear only and unable to valsalva
Treated by NAMI (10 SEP 1987), cleared to fly
Have had continued clicking in left ear since this incident
Summer of 2003 had numerous instances where I temporarily lost and regained hearing in my right ear (usually less than 1 minute)
15 SEP 2003 Viral URI which became Sinusitis, treated with Amoxicillin and cleared to fly on 17 SEP 2003
18 OCT 2003 left a cruise ship after a 7 day cruise where I had done a 2 tank dive. The dive was within limits and included safety stops. I had the sensation of water in my right ear and used swimmers ear drops to clear out the ear. After debarking 3 days later, I had the sensation I was still on the ship for 4 continuous days. Then intermittent pitch and roll sensations triggered by jaw movements (talking or chewing)
In November 2003 first noticed vection (the sensation I was still moving after I stopped driving or when an elevator stopped). I got my first tilting sensation when walking down long passageways, I felt like I was tilted 10° right wing down.
Portsmouth/Sewells Point took following actions
Sinus X-Ray (Found some congestion)
Head Tilting Exercises (Aggravated the apparent motion)
MRI (no abnormalities)
Audio gram (normal)
Rotating Chair/ pneumatic ENG (75% unilateral weakness on the right side)
Fistula check (normal results)
Nuero Exam (Nystagmus noted, no DCS symptoms)
Prescribed Head exercises (they were ineffective)
December 2003 had what I thought was flicker vertigo. While driving past bare trees with the sun low on my right side I developed a migraine on the right side, became nauseous and it appeared the road was doing barrel rolls to the right. Ive had 2 more instances of this sensation and avoid driving when the sun is low on my right side.
January 2004, I reported to NAMRL for further testing
I performed in the normal range on balance testing
I had prolonged after effects to visual stimulation or motion
My doctor consulted with a Neurologist who thought I might be having Migraine induced symptoms or that this might be a variant of Menieres Disease
He conducted an EEG and found strobe lights could induce a migraine
He prescribed Callan which reduced my after effects and vection but did not resolve all symptoms
Audiologist conducted a water based ENG with the same results of my first test in Portsmouth
Symptoms steadied out to:
Vection
10° right tilting sensation with eyes closed
10° right tilting sensation when walking down long passageways or close to walls
Occasional muting in the right ear
Ringing in both ears when reclined
February 2004 Conducted full blood screening (all results normal)
March 2004, I reported back to Norfolk
On the trip back up to Norfolk developed pressure in the right ear only (able to valsalva, but pressure remained)
Increased Callan Dosage developed swelling in ankles, reduced Callan dosage
Conducted MRA (normal)
Found colder weather increased the intensity of symptoms
While walking on the second floor of a building with a bay to my left side and below, became disoriented.
While walking near police strobe light, became disoriented.
April 2004, diagnosed by an Otologist with Mal De Debarquement Syndrome
May 2004, my Neurologist noticed what might be an abnormality on the MRA
Repeated the MRA and found the same thing, later determined that it was normal
Right ear pressure became intermittent, but long lasting
June 2004, diagnosed by a Neuro Otologist with Right Superior Vestibular Ganglionitis
Flew to Boston
Increased vection from flight
When I looked down out of the parked plane it felt like I was moving in reverse
When I would look back in the cabin it felt like I was being shuttled fore and aft
While airborne, plane penetrated cloud deck and I immediately felt like I had rolled 10° to the right.
Performed ECG (normal range response)
Prescribed Robinol (No effect on symptoms)
August 2004
Prescribed Klopinin (caused depressed state but no effect on symptoms)
Prescribed Valtrex (No effect)
September 2004
Prescribed Scoplamine Patch (No effect)
October 2004
Underwent Intratympanic Labyrinthotomy (No reduction in symptoms, but caused continuous ringing in the right ear that still exists)
Prescribed Acyclovir (No effect)
November 2004
Prescribed Callan (Again reduced vection but after 3 days got swelling in the ankles and wrists and had to stop this med) However, after getting off the ship while still taking the Callan, I did not have the sensation I was still on the ship.
Went on a 5 night cruise
Felt like I was on the ship for over 2 weeks after debarking
After the 3rd week, pitch, roll and yaw sensations could still be triggered by jaw movements or tilting my head fore or aft
Had a new sensation that when walking felt like I was standing in the surf (being pulled back then pushed forward by a wave)
Failed balance tests at NAMRL
Had a Migraine triggered by a flashing strobe on a school bus
December 2004
2nd Water based ENG found 80% unilateral weakness on the right side.
Audiogram (Normal)
Had a Migraine triggered by flashing lights at a wedding reception
January 2005
Steady state symptoms include;
Left yaw induced by tilting my head fore or aft
10° right tilt sensation with eyes closed
10° right tilt sensation when walking down long passageways
Continuous ringing in the right ear in all orientations
Ringing in the left ear when reclined
Periodic and brief muting of the right ear
Long lasting pressure in the right ear only
(pressure will change with head orientation)
Vection after moving
On cold days still have an occasional occurrence of the standing in the surf sensation while walking
Flickering lights still cause migraines
Cannot consume alcohol or caffeine without an increase in symptoms
February 2005
Started Maxzide. After about 7 days the Maxzide started to have and effect on the right tilt sensation but tilt sensation would return after a flight or long drive.
March 2005
Seen by different Neuro Otologist
Had Enhanced CT scan, and another MRI (normal results on both tests)
Had a migraine triggered by the Hampton Roads Bridge Tunnel
Started taking Nimotop.
Had tube installed in Right Ear to try to get rid of pressure sensation.
Note: I have been fishing in the bay in choppy seas and do not get the sensation I'm still on the boat like I did on the cruise ship. I have also been on 6 hour kayak trips without getting the sensations I had when I left the cruise ship. Also, in case you are worried, I have not been at the controls of an aircraft or been diving since my personal tilt-a-whirl started.
During flight school had stretched Eustachian Tube in my right ear, continuous pressure in right ear only and unable to valsalva
Treated by NAMI (10 SEP 1987), cleared to fly
Have had continued clicking in left ear since this incident
Summer of 2003 had numerous instances where I temporarily lost and regained hearing in my right ear (usually less than 1 minute)
15 SEP 2003 Viral URI which became Sinusitis, treated with Amoxicillin and cleared to fly on 17 SEP 2003
18 OCT 2003 left a cruise ship after a 7 day cruise where I had done a 2 tank dive. The dive was within limits and included safety stops. I had the sensation of water in my right ear and used swimmers ear drops to clear out the ear. After debarking 3 days later, I had the sensation I was still on the ship for 4 continuous days. Then intermittent pitch and roll sensations triggered by jaw movements (talking or chewing)
In November 2003 first noticed vection (the sensation I was still moving after I stopped driving or when an elevator stopped). I got my first tilting sensation when walking down long passageways, I felt like I was tilted 10° right wing down.
Portsmouth/Sewells Point took following actions
Sinus X-Ray (Found some congestion)
Head Tilting Exercises (Aggravated the apparent motion)
MRI (no abnormalities)
Audio gram (normal)
Rotating Chair/ pneumatic ENG (75% unilateral weakness on the right side)
Fistula check (normal results)
Nuero Exam (Nystagmus noted, no DCS symptoms)
Prescribed Head exercises (they were ineffective)
December 2003 had what I thought was flicker vertigo. While driving past bare trees with the sun low on my right side I developed a migraine on the right side, became nauseous and it appeared the road was doing barrel rolls to the right. Ive had 2 more instances of this sensation and avoid driving when the sun is low on my right side.
January 2004, I reported to NAMRL for further testing
I performed in the normal range on balance testing
I had prolonged after effects to visual stimulation or motion
My doctor consulted with a Neurologist who thought I might be having Migraine induced symptoms or that this might be a variant of Menieres Disease
He conducted an EEG and found strobe lights could induce a migraine
He prescribed Callan which reduced my after effects and vection but did not resolve all symptoms
Audiologist conducted a water based ENG with the same results of my first test in Portsmouth
Symptoms steadied out to:
Vection
10° right tilting sensation with eyes closed
10° right tilting sensation when walking down long passageways or close to walls
Occasional muting in the right ear
Ringing in both ears when reclined
February 2004 Conducted full blood screening (all results normal)
March 2004, I reported back to Norfolk
On the trip back up to Norfolk developed pressure in the right ear only (able to valsalva, but pressure remained)
Increased Callan Dosage developed swelling in ankles, reduced Callan dosage
Conducted MRA (normal)
Found colder weather increased the intensity of symptoms
While walking on the second floor of a building with a bay to my left side and below, became disoriented.
While walking near police strobe light, became disoriented.
April 2004, diagnosed by an Otologist with Mal De Debarquement Syndrome
May 2004, my Neurologist noticed what might be an abnormality on the MRA
Repeated the MRA and found the same thing, later determined that it was normal
Right ear pressure became intermittent, but long lasting
June 2004, diagnosed by a Neuro Otologist with Right Superior Vestibular Ganglionitis
Flew to Boston
Increased vection from flight
When I looked down out of the parked plane it felt like I was moving in reverse
When I would look back in the cabin it felt like I was being shuttled fore and aft
While airborne, plane penetrated cloud deck and I immediately felt like I had rolled 10° to the right.
Performed ECG (normal range response)
Prescribed Robinol (No effect on symptoms)
August 2004
Prescribed Klopinin (caused depressed state but no effect on symptoms)
Prescribed Valtrex (No effect)
September 2004
Prescribed Scoplamine Patch (No effect)
October 2004
Underwent Intratympanic Labyrinthotomy (No reduction in symptoms, but caused continuous ringing in the right ear that still exists)
Prescribed Acyclovir (No effect)
November 2004
Prescribed Callan (Again reduced vection but after 3 days got swelling in the ankles and wrists and had to stop this med) However, after getting off the ship while still taking the Callan, I did not have the sensation I was still on the ship.
Went on a 5 night cruise
Felt like I was on the ship for over 2 weeks after debarking
After the 3rd week, pitch, roll and yaw sensations could still be triggered by jaw movements or tilting my head fore or aft
Had a new sensation that when walking felt like I was standing in the surf (being pulled back then pushed forward by a wave)
Failed balance tests at NAMRL
Had a Migraine triggered by a flashing strobe on a school bus
December 2004
2nd Water based ENG found 80% unilateral weakness on the right side.
Audiogram (Normal)
Had a Migraine triggered by flashing lights at a wedding reception
January 2005
Steady state symptoms include;
Left yaw induced by tilting my head fore or aft
10° right tilt sensation with eyes closed
10° right tilt sensation when walking down long passageways
Continuous ringing in the right ear in all orientations
Ringing in the left ear when reclined
Periodic and brief muting of the right ear
Long lasting pressure in the right ear only
(pressure will change with head orientation)
Vection after moving
On cold days still have an occasional occurrence of the standing in the surf sensation while walking
Flickering lights still cause migraines
Cannot consume alcohol or caffeine without an increase in symptoms
February 2005
Started Maxzide. After about 7 days the Maxzide started to have and effect on the right tilt sensation but tilt sensation would return after a flight or long drive.
March 2005
Seen by different Neuro Otologist
Had Enhanced CT scan, and another MRI (normal results on both tests)
Had a migraine triggered by the Hampton Roads Bridge Tunnel
Started taking Nimotop.
Had tube installed in Right Ear to try to get rid of pressure sensation.
Note: I have been fishing in the bay in choppy seas and do not get the sensation I'm still on the boat like I did on the cruise ship. I have also been on 6 hour kayak trips without getting the sensations I had when I left the cruise ship. Also, in case you are worried, I have not been at the controls of an aircraft or been diving since my personal tilt-a-whirl started.
