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sudden unexpected loss of balance
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pleasehelpme87 posted:
Hi, the reason Im posting is because I got up like any other day today, went to the bathroom and as I was washing my hands, I suddenly felt a big loss of balance.

I was standing upright and then my balance shifted over to my left side causing me to bend over to the left, I thought I was going to fall over but I managed to grab the wall with my other arm before doing so.

The experience lasted about five seconds, but it left me very concerned and worried and a bit disoriented (it could have been because I was so worried). It is kind of similar to if you get up instantly from a laying down or seated position to standing, which makes you lose your balance and can make you tip over.

I visited the doctor today who told me these things are middle ear problems not brain problems, and look into my mouth and ears, he said my throat is somewhat red indicating infection which can go to the middle ear. He said when the infection is ok, it will stop too. Does anyone have experience with this kind of thing? For some reason, I want to believe him, but I keep thinking this could be wrong (something much more sinister). I told the doctor about my history of pulsatile tinnitus from about 2009/2010 (had this checked by specialist like two years back, had mri, it was ok), the doctor I saw today said dont worry about that.
The doctor said to simply take advil for these first two days and drink water, and when the infection is gone, the balance will be ok. I told the doctor I dont think I have a cold/flu or an infection due to lack of symptoms, but he said there is redness regardless indicating even slight infection you probably dont notice. Im just worried and confused, any thoughts?
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Rod Moser, PA, PhD responded:
Vertigo may be one of the most difficult medical conditions to diagnose and treat. There can be hundreds of causes, involving nearly every body system, but commonly in the inner ear. The mechanism of vertigo is very complex. People with vertigo will tend to use words such as spinning, tilting, swaying, or rotating. Vertigo is a hallucination or feeling of movement. The most common type of vertigo is a sensation that a person's surroundings are spinning around them.

The sensation most often arises from a part of the inner ear - the semicircular canals. Under normal conditions, the position and movements of the head are detected by tiny hair cells in the semicircular canals. Movements cause hair cells to transmit impulses to the brain. Calcium carbonate crystals or otoliths that are usually embedded in the membrane may occasionally float freely within the fluid of the semicircular canals. When free-floating crystals migrate to the far ends of the semicircular canal, these crystals cause a person to sense movement when there is none. Vertigo can also arise from the brain itself. The various tests that are performed (MRI, CT scans, ENG, etc.) are all important to help pinpoint the location of the problem. Unfortunately, a cause is often not found in many cases, so people (and their medical providers) are often left frustrated.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. The person usually describes bouts of recurring vertigo lasting several minutes or less. Episodes may be as brief as 15 seconds. Specific movements of the head often provoke the attack, usually following a brief delay of several seconds. Patients can often indicate the specific head motion or motions, which tend to trigger an attack. Hearing loss and tinnitus are not associated with BPPV.

The second most common cause of vertigo is labyrinthitis. The disease is thought to be a sequel of a viral infection, like a simple cold or even the herpes virus. It is gradual in onset, reaches maximal intensity within one hour, and resolves within 24 hours. The episode is associated with nausea and vomiting. Hearing loss may or may not be seen. There is often a significant phase of disequilibrium (balance problems) that may persist from days to months.

M?ni?re's disease consists of recurrent episodes of vertigo associated with hearing loss, tinnitus (ringing in the ears) and a feeling of fullness in the ear. Either ear may be affected initially; the condition may involve both ears as the disease progresses. Low frequency hearing is lost initially; a more global loss is seen in time. Episodes begin suddenly and characteristically last from thirty minutes to 24 hours. Episodes can be frequent and disabling.

Acoustic neuroma is the most common tumor that can cause vertigo, but fortunately, they are relatively uncommon. Searching for an acoustic neuroma is one of the main reasons imaging studies (MRI, CT scan) are done.

Other medical conditions that are associated with dizziness and vertigo include: medication side effects, otitis media (middle ear infections), sinusitis, migraines, trauma, brainstem dysfunction, multiple sclerosis, diabetes, reactive hypoglycemia, anemia, hypovolemia (loss of blood), hypoxia (low oxygen), hyperventilation syndrome, epilepsy, heart rhythm problems and other heart disease, and brain tumors. There are even psychogenic causes.

Even if a cause of vertigo is not found, and all of the serious causes (tumors, etc.) have been ruled out, this medical condition can be successfully treated, either with medications or rarely, surgical methods (depending on the severity). Seeing a specialist that has some expertise in vertigo and balance disorders is often the best way to go. Many of these specialists are associated with large, university-based medical centers. I often recommend that patients have a consultation at this level if this is happening to you often and a cause is not easily found.
 
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pleasehelpme87 replied to Rod Moser, PA, PhD's response:
Thank you Dr. Moser for your reply.

I ended up going to the hospital that same day when I awoke in bed with a pretty bad spinning/tilting/falling sensation in my head. I was having a lot spinning and nausea.

The blood work they did there was ok they mentioned. I was given a CT scan there and when the doctor returned he didnt make mention of the scan results (probably it was ok since he didnt say anything about it) but told me that the problem with my balance is in my right ear.

He said something about the fluid and transmission of signals and how that is causing the problem. I asked what the problem is called and he said Vertigo Vestibulitis. He said this is related to colds/flu or infections.

The thing that concerns me is that he said there is no treatment for this and to just wait for it to get better (if it ever does, which he said too). He prescribed Serc (he said not to cure it) but to help me during the time it takes to get better.

Do you have any ideas or suggestions?
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
Your diagnosis is really the same as LABYRINTHITIS, thought to be a complication of a simple viral infection or cold. There is really not guarantee that you will not have any residual vertigo or even tinnitus (ringing), but the vast majority of people do get better. Some of us (yes, me) do end up having some residual symptoms years later...mine is just tinnitus. The vertigo is very rare now.

Take the SERC (an antihistamine). It may help the symptoms, but it is your body's immune system that is trying to orchestrate the cure.
 
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pleasehelpme87 replied to Rod Moser, PA, PhD's response:
Hi Dr. Moser, thank you for your reply.

After doing some reading on labyrinthitis, I have some questions and concerns. One article I read (http://www2.utmb.edu/otoref/Grnds/Labyrinth-0005/Labyrinth-0005.htm) says labyrinthitis can be caused by a number of very serious and concerning viruses like hiv. The article also says that labyrinthitis can lead to meningitis.

Whenever I hear hiv I get pretty scared because its a scary thing. Say a person has intercourse (wear condom, insertive vaginal) and then gets tested 1-2 years after that with a rapid finger prick hiv test in clinic (called insti hiv test), testing negative. Then they develop labyrinthitis 3-4 years after that sexual encounter, does this seem like a valid concern? Can the two incidents be related? Is labyrinthitis an illness that develops days after an infection or years after some infection? Im just really concerned.

I havent had a cold or flu in the past few months or if I recently did, I didnt notice.
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
Labyrinthitis is relatively common, and is usually due to one of the 200 or so respiratory viruses. I have never seen HIV associated (or even meningitis) labyrinthitis, but I guess it is possible. It would be extremely unlikely that your labyrinthitis is related to a (safe) sexual encounter 1-2 years ago.
 
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pleasehelpme87 replied to Rod Moser, PA, PhD's response:
Hi Dr. Moser, thank you for your reply.

I was curious as to whether or not a person can get labyrinthitis by picking their ears with their fingers? I have often noticed that I find myself sticking my finger into my ear unknowingly sometimes to clean or scrape out ear wax, usually after bathing, it has become a kind of habit now. Or even from wearing or re-wearing ear plugs (for decreasing noise in loud work environments)?
 
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pleasehelpme87 replied to pleasehelpme87's response:
Hi Dr. Moser, thank you for your replies to my previous questions I have asked you on here. Your advice and opinion do not go unappreciated.

I was hoping to get your opinion, thoughts, impressions or any advice on my general state of health, if I could.

In early 09 I got a sore throat for which I took antibiotics, the throat got better in a matter of days, but the antibiotics lead to c diff infection. The infection itself was severe (pains, nausea, diarrhea, then vomiting and blood in diarrhea). I was given flagyl for the c diff. The pains and diarrhea settled after a few days, but the nausea persisted for a long time after. This is about where my problems commenced and before this I didn't have any health problems (that I know of, besides having asthma during childhood, Im 24 year male now, Ive been waiting since this to get 'ok' again and finish school).

A general being of feeling tired, nauseous and generally not good began after c diff.

About a month or so after c diff, I developed Pulsatile Tinnitus in my right ear, I went to the ENT and he said it was ok, but I got an mri anyways to be sure. The mri didn't show acoustic neuroma, but there was some demyelination in brain matter. The GP said, don't worry about it and that this shows up often in any mri. I still have Pulsatile Tinnitus, I notice it when turning my head far left or in silence.

About the same time as I noticed the Pulsatile Tinnitus I started to notice blurred and double vision, the double vision happens when make head movements or quick eye movements usually. I went to the Optometrist as of this month, but he said he didn't find anything and to just monitor it.

(Pulsatile Tinnitus and vision problems began around 09 and persist today, feeling of nausea began during c diff and bugs me to this day, this has been a real problem and has put my school life on hold since)

Then as of this month, as you know, I got the vertigo problem, and was diagnosed with labrynthitis in right ear too.

Im not sure what is going on, but I haven't been the same since c diff and am trying to get back to 'normal'. Sometimes I think probably something sinister going on, but just don't know what.
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
You would have to pick very far to interfer with your labyrinth...nearly to your brain, so I don't think your ear (canal) picking or the minor inflammation from your ear plugs has any relationship whatsoever.
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
The MRI rules out most of the sinister problems that you are worrying about. The MRI is more helpful in telling your doctor what you DON'T have, then really telling what you DO have. In this case, a negative MRI is good news.

I have no idea what your Pulsatile Tinnitus seemed to occur the time time you were dealing with C.diff, other than a coincidence. I have never heard of a direct association, at least from my primary care perspective and experiences.
 
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pleasehelpme87 replied to Rod Moser, PA, PhD's response:
Hi Dr. Moser, thank you for your reply to my question.

The mri was specifically looking 'to rule out acoustic neuroma'. Im not sure if anything else in specific was checked for.

Do you think there could be a possible connection with pulsatile tinnitus and labrynthitis? Or even, pulsatile tinnitus and vertigo occurring a couple years after pulsatile tinnitus initially began? Taking into account, both of them are occurring in the same ear. I wasnt given a formal explanation for the pulsatile tinnitus either.

Im just trying to think of what thing(s) can cause nausea, blurred/double vision, pulsatile tinnitus and vertigo. Im still dealing with residual effects from the vertigo. My head is feeling a bit heavy and unusual since the vertigo, and a kind of unsteady gait when walking.

When I look up pulsatile tinnitus there are so many unusual things that can cause it other than acoustic neuromas, like problems with arteries and blood vessel walls, lyme disease, fibromuscular dysplasia, intracranial hypertension, and MS.

Im just kind of at odds with what to do in case something is going on and if left ignored can lead to something else, and having frequent symptoms for about three years also makes it hard to ignore and think its nothing.
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
There is usually NOT a connection between PT (pulsatile tinnitus) and labyrinthitis, but both can cause some of the same symptoms. You are correct that PT is usually vascular but not all vascular problems are "sinister" as you fear. Sometimes, PT is simply caused by hearing an adjacent artery or a branch of the jugular vein (this vein has a pulsation, like an artery). An MRA (a contrast dye is used) to look for these vascular causes, but a regular MRI is used to rule out the brain causes (like MS, etc.)

Odds? Medical people don't really use odds in this way. Of course, your doctor is searching for a cause and has considered these more sinister causes among them. Again, the MRI is more useful in ruling out the bad things, than actually providing the diagnosis.
 
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pleasehelpme87 replied to Rod Moser, PA, PhD's response:
Hi Dr. Moser, thank you for the response, has your cold/flu resolved itself yet?

Ive been trying to see a new doctor recently for my health. He was quite busy today and asked what was wrong. I was trying to explain that it is not one symptom, but I have a few symptoms stemming back since 09. He was quite busy and in a rush, so I gave a brief overview of what happened (the things I wrote to you above about 3 weeks ago).

He gave a blood test to do (hematology profile, ferritin, glucose, suspected hypothyroidism, sodium, potassium, ALT, creatinine/eGFR, creatine kinase (CK), CRP, vit B12, Vit D 25 OH), and said this will help and to discuss more after.

The question I have for you is the following: what would you do if you were me? If say you had c diff in 09, had on and off nausea since, general fatigue, then got Pulsatile Tinnitus and around the same time Blurred/Double vision, and then Labrynithitis recently. Would you just try to ignore it all and try to move on, or would you not? My life has been on hold and I really want to move forward, but I dont know what or how to do so.
 
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pleasehelpme87 replied to pleasehelpme87's response:
Another thing I wanted to ask was about the blood test he ordered. How much can the test really say? If it all turns out to be in the 'normal' range, does that mean there really isnt anything going on, or that there still can be something going on but it just wasnt looked for?

If people have autoimmune diseases or something similar, how do they find out? Would the things tested above look for all that? Or are there some other specific blood tests/other tests that check for it? Thank you.
 
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Rod Moser, PA, PhD replied to pleasehelpme87's response:
These blood tests are just the BEGINNING of your diagnostic work-up. If they come back normal, this is reallly good news....would you really want them to abnormal? Since there can be hundreds of diagnostic considerations, this process can be lengthy and even frustrating. Tests tend to be "layered"....do the basic ones first, and then more detail ones later.

I really cannot second-guess how your doctor is approaching this problem; what his next plans are, etc. What I would do in a clinical situation is really irrelevant. It is what YOUR DOCTOR is going to do that is important. My practice of medicine may be completely different, but that does not mean I am the "gold standard" of care. There are MANY, excellent ways to approach this very difficult issue, so I really cannot get involved at that level by commenting on your case management. It would not be prudent or ethical for me to do so, since I am not involved in your care.

And, to head you off at the pass....I make it a rule NOT to interpret individual test results out of context. ONLY your doctor should do this, so as much as I would like to help you, please do not post your test results. They need to be correlated with your cllincial findings in order to be accurately interpreted.

You have complex array of symptoms, so it is going to take time for your doctor(s) to sort them out. Be patient and do not be hesitant to ask your doctor as many questions as you can write down. That is there job.


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