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Vestibular Neuritis

Old 14th Jun 2008, 10:43
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I hope you can forgive my ignorance, but how can an MRI of the spine and upper neck be relevant to a vestibular issue?

BTW - Electrocochleography is performed by having you lie on a table, with electrodes connected to your forehead (I believe they can also connect them to other places). It measures electrical impulses while your ears are stimulated by a series of clicks. It took about half an hour in my case. The electrodes were mounted just above nose bridge and at top of forehead. They used an abrasive sponge to get them to take to the skin, and it left marks for a week or so later - I was a bit concerned people might recognise the marks and think I'd flown over the cuckoo's nest!

Last edited by WG774; 14th Jun 2008 at 10:54.
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Old 14th Jun 2008, 19:54
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The reason they performed an Mri of the upper spine and neck relates to (coincidentally but they are not sure) a neck 'injury' I suffered around the same time as the, initial sinus infection that precipitated my balance issues.

I use the inverted commas because this injury, strangely enough came about as a result of using a different pillow and waking up one morning with my head and neck in such an uncomfortable position I could hardly move my Noggin for 10 minutes or so, I have had neck pain ever since.

The Doctor thought this could be a factor in my balance issues.

I did have the other test you described, I remember it well because of the abrasive matter on my forehead.
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Old 14th Jun 2008, 19:56
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Not sure about the Unterberger test no 1Mutt I shall look into it.

Thank you.
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Old 15th Jun 2008, 05:49
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use the inverted commas because this injury, strangely enough came about as a result of using a different pillow and waking up one morning with my head and neck in such an uncomfortable position I could hardly move my Noggin for 10 minutes or so, I have had neck pain ever since.
Curiously, I had a similar problem during my layoff with Labyrinthitus. I'm not convinced though that it had any direct bearing on the condition. I believe my imbalance was caused by a virus getting into the inner ear.
However, while I was kicking my heals for nine months, I attended the McTimmoney Chiropractic School in the UK. By donating my body to the benefit of the students and instructors, I sorted out a lot of my back problems. I found that for me, at least, this method of treatment was very beneficial and some of the very gentle tweaks and twists had a direct influence on the balance mechanism. I had trouble walking to the car afterwards! I would suggest that it could be worth looking for a McTimmoney practitioner in your area.

By the way, has your Blood Pressure started to rise? I was naturally prone to raised BP and the stress of this condition meant that it started going off the scale.

It will get better.

Best wishes
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Old 15th Jun 2008, 16:13
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I use the inverted commas because this injury, strangely enough came about as a result of using a different pillow and waking up one morning with my head and neck in such an uncomfortable position I could hardly move my Noggin for 10 minutes or so, I have had neck pain ever since.

The Doctor thought this could be a factor in my balance issues.
Am I right to assume that your Doc felt that your neck injury could cause bad posture, thus affecting the way you balance your head and hence influence overall balance?

If the above is the case, you could always buy a book on Alexander Technique. It's controversial as the results are tricky to quantify, but other members here have benefited from it - try a search.

Something I came across that's interesting is the work from Dr Galiffa in Italy (try a Google). Galiffa has pretty good credentials, and his book (in Italian - no English version yet, annoyingly) is all about sleeping posture. He believes that bad sleeping posture can put pressure on the jaw, potentially unleashing a Pandora's box of vestibular / audiological issues, such as tinnitus and balance problems - to name two. Galiffa has a book to sell, so be warned, but his ideas are interesting IMHO.

Stilton - do you sleep on your front?
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Old 15th Jun 2008, 20:55
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Oyyou,

Yes, I have been seeing a Chiropractor and it has been somewhat helpful,
my blood pressure has generally been ok but I have found this condition certainly worsens with stress.
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Old 15th Jun 2008, 21:01
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Wg7

The Neuro-otologist I saw thinks the Neck Problem could be related to my balance issue, but he is not really sure and neither am I.

I still think it is virus related, as I nearly always feel like I have a head cold, congested with clicking in my ears when I swallow, (like being unable to clear out your ears when descending)

I shall look into the sleeping posture issue, I always sleep on my side (right usually)
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Old 16th Jun 2008, 10:15
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I have a bit of a history of inner ear problems too.

I am not sure if what I have put up with on and off for years is related to your problems stilton, but I do think that some habitual sleep positions can be unhelpful. When things are good, I try to vary my sleep position, or fall asleep flat on my back (which isn't good for other reasons but does introduce some randomness as to which side I end up on!). I also have a long term minor neck problem but hadn't linked it, but who knows - we're all different, and neck problems clearly are often central to stress and tension affecting the head.

I do have some permanent tinnitus but I am lucky that it is high pitched and mild so it is always very easy to tune out and most days I go all day without noticing it at all.

Years ago I saw a specialist after a wobbliness with nausea episode and they toyed with the Menieres tag. I tried SERC (betahistine) with no conclusive result. Some people report on the internet that they had to trial different dosages before they got it to work. Not sure where you are based, (Stilton is in Leicestershire, UK I think) but I think betahistine hydrochloride is banned in US. Not sure why. You can get it in Canada I believe. I am not sure if any reliance on it is approved anywhere for pilots? But apparently it helps some people.

I have very occasionally experienced that clicking in the ears you mentioned I think, associated with more frequent other symptoms like 'fullness' in one ear in particular. Because of what I am about to post next, I wonder if the clicking is anything to do with excess calcium deposits.

I too firmly believe that avoidance of stress is essential to keep symptoms / episodes at bay.

I haven't needed to revisit any specialist for years but the last time I had an episode of 'fullness' which resulted in a little annoying vertigo (which can come on quite suddenly and is therefore a important self-diagnosis self-grounding issue if you recognise onset) I spoke to a European friend of a friend who said "Oh I had that recently and my doc gave me a simple exercise and it went straightaway!"

So I had to investigate!

What he had, and what I have had once or twice since learning about it, is basically calcium deposits that have become loose in part of the inner ear.

The condition is known by its acronym BPPV (Benign paroxysmal positional vertigo). The exercise/manoeuvre also has a name and I will go hunt for it.

Anyway, I tried his trick straightaway and there was some immediate improvement. Prior to the next episode I had, I also caught a programme on BBC Radio 4 which advocated the same thing for self help. It's the single most useful thing I have learned about my own inner ear problems and sometimes in the past, I have struggled for as long as a month or more with various symptoms.

You say you don't suffer vertigo, but many inner ear problem sufferers often do eventually. So whatever else may be occurring in your ear (the suspected viral damage), if you ever do start getting balance problems do consider that a crystal or two of calcium may have come loose, especially if you are no longer a youngster! The 'exercise' or manoeuvre is simply a systematic three positions one minute each for your head which basically tips any loose calcium crystals into a dark corner where they are not interfering with balance or anything else. Its a bit like one of those ball bearing toys where you have to sit all the balls in the holes simultaneously!

I am guessing that some people have a genetic or dietary pre-disposition to some of these problems. My mother has suffered from tinnitus since middle age. But moe practically, I assume that excess calcium is often associated with too many dairy products in a diet? Is your username a clue to your own dietary preferences? ... pass the port with that, old chap?

(Obviously?) alcohol consumption even at low levels may be unhelpful as I remember from ATPL theory that there is a mini-sac in there somewhere, essential for controlling balance, but which is detrimentally prone to soak up alcohol and not disperse it again for maybe as long as a day or two.

As has been suggested generally, I have no doubt that my own vestibular equilibrium has been re-trained to some possibly considerable extent over the years. I can remember times past when I could not stand on one leg in the shower with soap in my eyes

I am sure you will come to understand your own symptoms and beat it, so the very best of luck with that, and I hope, like others, that relating my experiences might be at least partially helpful. As I say, the most important thing I believe is to avoid unrelenting stress, and in your line of work to learn to self-diagnose early onset if you find you improve but start to slide back. Unfortunately if that happens, you might this time get completely clear (I hope you do), but suddenly get this back again in a few years. At that point, you obviously don't wouldn't want it to take you by surprise in the wrong place

Last edited by slip and turn; 16th Jun 2008 at 10:28.
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Old 16th Jun 2008, 12:26
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That's some very interesting information there, Slip-n-turn - thanks for posting.

If you can find a link detailing this manoevre that helps shift calcium deposits, I'd be very interested to see it.

Also, it's been said before, but for anyone who's been grappling with a suspected inner ear problem over time, I believe it's essential to visit a Maxillofacial Surgeon and rule out a TMJ issue. Bear in mind that ENT / Oto-neurologists aren't 100% equipped to diagnose TMJ - it can be subtle and non-obvious, and the only person who will be able to diagnose a slight misalignement will be a Max-Fac specialist.

One link I found referred to TMJ as the "great imposter" because its symptoms mimic that of so many conditions. General stress and jaw-clenching can also cause tinnitus and vestibular issues.

I also have identical symptoms to you, S+Turn. The Oto-specialists have said my hearing's good, and they are blaming stress... I'm open-minded about it being stress, but the clicking is not my imagination, nor the occasional sharp pains I get in the jaw joint when yawning. I'm off to see a Max-Fac guy - if he can rule it out, I can really focus on not being a stress-monger!
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Old 16th Jun 2008, 13:37
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Hi WG!

I have Googled for manoeuvre BPPV head tilt and so far have discovered three named manoeuvres - including one for dogs - I am not sure if they are all the same thing - Epley, Hallpike and Semont all figure on the first page of hits.

The one I (*Edit: thought I'd) learned was simply
1) identify the ear that appears to contain the affliction (the "full" ear?)
2) sit upright on the middle of the edge of the bed. Turn head slowly in horizontal plane by 45 degrees away from bad ear.
3) very slowly fall sideways keeping head and trunk in same relative positions until you are resting your bad side on the bed and your nose is half pointed at the ceiling and stay there for 1 minute
4) * (wrong I think - see below) very slowly return to sitting upright still keeping head at same relative angle.
5) * (wrong I think - see below) very slowly descend sideways the other way, still keeping head at same angle so when your good side is on the bed, your nose is half buried in the bed this time. Stay there for 1 minute
6) very slowly return to upright position and then try it out but try not to make any sudden movements or acute angles for an hour or two.

It doesn't always work, but the guy who told me about it was coached through it by his G.P. and it was solved completely and immediately when he got up from the couch. He also had a very stressful job (CEO of a largish company).

As I said earlier, the first time I tried it myself, it helped. It wasn't complete but it helped me. I think I've used it three times in anger. Second time helped instantly and more or less completely. Third time was a bit like the first. Depends what the exact problem is of course, and if loose calcium isn't part of it then just imagine an improvement ... anything is better than the room going round

But I'd better look up the timings so you aren't wasting too much time on this ! - yes 1 minute each side per the article I've now linked to below.

Now I shall take a look at those TMJ aspects - something I hadn't come across previously.

Thanks WG

* Edit: It seems there are indeed three different named manoeuvres , each with their purpose ... HallPike for diagnos, and Epley or Semont for treatment.I think mine was Semont except I have remembered part of it completely wrong above - the bit in steps 4 and 5 where my use of the words very slowly looks completely wrong now according to this paper where I think the 180 should also be completed in one single step: http://www.acnr.co.uk/pdfs/volume5is...5i3revbbpv.pdf

which states: In this position (my position 1) vertigo is triggered and torsional nystagmus beats toward the affected (undermost) ear.
After being kept in this position for approximately a minute (so all debris falls to the bottom), the patient is swung rapidly onto the opposite side of
the couch (and stays there for another minute) (Figure 3 - 2,3). The manoeuvre should be executed quickly in one single movement step.

Maybe that's why I've only been partially successful with it twice out of thrice ... oops ... must stop doing that

Last edited by slip and turn; 16th Jun 2008 at 15:06.
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Old 26th Jun 2008, 22:47
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Thanks WG and Slip and turn,

I have tried the BPPV manoeuvre with, perhaps a little success.

Still going to Vestibular Therapy, Accupuncture and a Chiropractor, seems to sloooowly be improving.

All the best.
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Old 27th Jun 2008, 12:20
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WG - Very interested in your Max Fac visit. Had balance, focus and ear issues earlier this year with some residue and have had jaw issues (jaw locking open whilst yawning, excessive teeth grinding also causing issues) in the past. This is one avenue I haven't explored and very interested in your views.

Thanks
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Old 27th Jun 2008, 13:36
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I also had this disabling condition about two years ago.

During a series of flights I gradually felt more and more unwell- like I had the flu or something. On my last flight, I started to feel dizzy and was sick. If I moved my head it was worse.

When I finally managed to get home I couldn't get out of bed the next day. When standing, I fell. My GP diagnosed Labyrinthitis and was told to rest and it would probably go away in a week or two.

After two weeks off work I felt a lot better and my balance was normal again but I still had a fullness in my ear- like it was full of water. The GP referred me to a consultant ENT surgeon who examined me, checked my eye response to stimulus (turning my head) then did a full audiology examination and a pressure test of my ears (which showed that there was no fluid behind my eardrum). On these tests he said my labyrinthitis was better and cleared me for a return to work. For my first flight I was concerned about the pressure changes in my ear but I was fine. After a few days, the fullness in my ear cleared totally and I felt 100% again- luckily!

Some people are not so lucky though- some never get over the symptoms and have to live with a constant feeling of vertigo and this must be very debilitating. Obviously, this would be a bar to flying. Menieres disease has similar symptoms and this would obviously have to be investigated.

I found a lot of information on this website:

Labyrinthitis.org.uk - support for Labyrinthitis sufferers.
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Old 28th Jun 2008, 20:19
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Bigsis - regardless of what my diagnosis proves to be, people are different, so if you suspect a TMJ issue, you need to see a Max-Fac consultant.

edit - Bruxism alone can cause the symptoms you mention, so you may not have a "full-on TMJ issue". Are you in a stressful job?

Also see this link: http://www.pprune.org/forums/4145111-post26.html

One thing I've learnt is that ear-related issues of this nature can be profoundly difficult to diagnose accurately. I've also learnt that the NHS has some of the most academically-acclaimed consultants. The only issue with the NHS is that wait... I've been treated by a few private consultants now, and conditions at the clinic were no better than NHS - it's just that I got in there pronto.

Let me put another cat amongst the pigeons: have any of you got back / spine pain issues? Despite my GP telling me it's impossible for there to be a connection, there is compelling evidence to suggest that Vertebral Subluxation Complex can cause balance / vertigo problems.

Getting a diagnosis never ends!

Last edited by WG774; 28th Jun 2008 at 20:29.
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Old 9th Oct 2008, 07:37
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Vestibular Neuritis..

I have mentioned my problems with this a couple of times on this forum but thought I would broach the subject again to see if I can elicit any new ideas.

Have been suffering from the symptoms of this on and off since the end of April this year, since then I have been unable to fly and am now on my Airlines disabled list.

I went through extensive and exhaustive testing by GP'S, ENT'S, Neurologists and Neurotologists, all negative, so VN is their diagnosis by elimination.

My symptoms are most pronounced when standing, a feeling of swaying and unsteadiness similar to being on a rolling ship in a heavy sea with a bias towards 'falling off to the right'

I also have occasional pain only in my left ear which does not seem to follow with my sensation of 'falling to the right' as I have read you will normally 'fall'
towards your 'bad' ear


ANY ideas suggestions, very welcome.
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Old 10th Oct 2008, 16:59
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Stilton, I can only say that I too am still having the symptoms of this condition. Mine started in March and has been diagnosed as Vestibular Neuronitis in the right ear.

I have been able to return to work because I am in Ops and not flying, but everyday life is a big struggle. It must be pretty rough having to give up flying for so long.

Not sure if I can offer any insights into this though! I have been doing the vestibular rehab exercises for over 5 months and my balance has not improved much. I have been told to try and force the vestibular system to retune itself by not using other senses for balance. This means balancing on foam with eyes closed and this sort of thing. Not sure how long compensation will take.
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Old 11th Oct 2008, 16:03
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With regard to 'fullness' in the ear, mentioned in some posts above, I experienced this quite badly around 1988 in my left ear after a particularly nasty bout of flu (real flu not a cold). As I described it to my GP it was as if some cotton wool was stuck to the inside of my eardrum. I could clear them ok flying and hearing test OK. Had them syringed and some wax scraped out with a long thin spatula instrument to no avail. Told nothing wrong. The sensation persisted and was variable in intensity. Return to GP about a month later, syringe and scrape and again told nothing wrong.

Explained all this at next licence medical. AME put me in dark cubicle with very bright light in my closed mouth. Looked in my ear and announced I had a clearly visible lump of catarrh stuck to the inside of my eardrum, which would have probably travelled up the Eustacian tube during the flu.

She explained this was not unusual and that it may come off within a week or stay there for the rest of my life. Well, it feels like it's still there sometimes, but doesn't bother me any more.
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Old 11th Oct 2008, 18:15
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Hey Stilton,
I was diagnosed with this condtion several months ago. However I went to see a neurotologist a few weeks ago who diagnosed me with having inner ear damage. Since then I have been given exercises to do which I must say have helped a fair bit. Although I don't think I'll be returning to flying for a few months yet I can see light at the end of the tunnel. I've been suffering for about 10 months so I can understand your frustrations.
I thought I sent you a private message with the Docs details but in case it's not there I'll try again.
Cheers
No1mutt
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Old 12th Oct 2008, 08:30
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Thank you for your replys Gentlemen, and your Link, No 1 Mutt, although I am on the other side of the Atlantic these days.Plz ck your pm;s

The latest my Doctors come up with I that it is 'all in my mind' very useful..

I have been trying the v rehab exercises Jimi with not much change so far.

I found the test involving the very bright light in your mouth most interesting
Hobo, have not heard of that, but you say that she could not do anything with what he found anyway ? puzzling.

The next thing to try will be wearing a Holter monitor for 24 hours just in case of a cardiovascular link.

I wish all of you a speedy recovery.
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Old 20th Oct 2008, 20:39
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stilton,
She did say that if it really bothered me than I could have a grommet fitted which would allow the catarrh to 'evaporate'. This was not recommended as infection could get into the inner ear through the grommet. She told me that there were a surprising number of pilots flying around with grommets fitted, (for other condidtions).
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