the Confusion Between Inner Ear Issues and Hypertension

The inner ear is affected by hypertension, and it can be difficult to distinguish between the two?

Hello, Dr.
Hong.
My question has a bit of history and may be somewhat complex, so I will ask in an organized manner.
I hope you can enlighten me.
Thank you.
1.
About 27 years ago, I got married, had children, and bought a house, which caused me immense stress and led to Meniere's disease.
I took medication for ten years without complete recovery, but eventually, I improved to about 90%.
Although I occasionally experience fluctuations, at least I no longer have vertigo.
2.
Fast forward to the end of 2013, I had a heart attack and received a stent.
Three months later, I started feeling dizzy again, but it was not vertigo!
3.
The ENT department at the same hospital said it was an inner ear issue unrelated to Meniere's disease, so I consulted a neurologist who arranged for a neck ultrasound.
It revealed a narrowing in the intracranial area, but it could not be determined if it was congenital or due to blockage.
I was advised to take aspirin from the cardiologist and to continue with my other medications, including Cerebrolysin and Edaravone.
4.
Since then, I have spent more time in a daze than being alert, feeling muddled until now!
5-1.
The main point of this message...
A few days ago, I woke up and suddenly experienced a strong dizziness, confirming that the surroundings were not spinning.
Lying down helped, but any movement caused dizziness—turning my head, looking up or down, or turning my body all made me dizzy.
When still, I felt fine.
The dizziness lasted about a minute, followed by a feeling of heaviness and nausea a few times.
Then, perhaps due to anxiety, I felt heat throughout my body but quickly recovered.
My blood pressure was 155/95 in my left arm, but the right arm showed an error.
After waiting half an hour and feeling less anxious, I measured again: 135/92 in the left arm and 140/95 in the right.
This situation eased after an hour.
The next day, due to the weekend, I went to an ENT clinic.
The doctor listened to my description and diagnosed it as inner ear inflammation or vestibular nerve issues, reassuring me that it was not a precursor to a stroke.
He prescribed some medications, one of which was a sedative, and I felt refreshed after taking it, but its effect lasted only about four hours.
5-2.
Since January 2014, I have been asking my neurologist every six months whether I need to undergo another neck ultrasound or other follow-up tests.
The doctor has always said it was unnecessary but advised me to be cautious! He also commented on my beer belly, suggesting that if I could reduce my abdominal fat, many issues could be alleviated.
He mentioned that the dizziness problem may never be completely cured! Wow...
I’m only 36 years old! (But my BMI is 27.5.) This has left me feeling anxious.
The neurologist is actually very nice, but his direct manner can be a bit intimidating!
5-3.
I can confirm that during this episode of dizziness, I did not experience facial numbness, abnormal sensations in my limbs, blurred vision, or hearing loss.
5-4.
What I am most worried about is the most severe issues, compounded by my tendency to suspect various problems since becoming ill.
Another point to mention is that I have had hearing issues in my right ear since childhood, along with tinnitus in my left ear.
Recently, my right ear has also been making strange noises.
When I’m fine, I feel like a lively dragon, but when I’m not, I feel like a worm.
I’ve rambled on quite a bit, and I hope Dr.
Hong can understand.
Thank you once again.

Mr. Zhang, 50~59 year old female. Ask Date: 2020/02/26

Dr. Hong Weibin reply Neurology

1.
Meniere's disease may improve dizziness gradually with age, but hearing loss may occur.

2.
Non-rotational dizziness may be related to internal medical conditions.
Factors such as medications, poor vascular circulation, and lack of sleep can contribute to this.

3.
There is a narrowed blood vessel in the brain; if further confirmation is needed, a CT angiography can be arranged, which requires a significant amount of contrast agent to determine the degree of narrowing.
However, the currently recommended treatment, if the narrowing is indeed severe, is to maintain aggressive medical therapy for stroke prevention, which is more effective and safer than placing an intracranial vascular stent.
For more information, you may refer to "Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis" from N Engl J Med 2011; 365:993-1003.

4.
If you experience significant drowsiness, it is advisable to avoid taking Cerebrolysin and Betahistine.
Both medications can suppress the inner ear system and lead to drowsiness.

5-1.
Your symptoms primarily consist of intense dizziness triggered by movement, without accompanying issues such as slurred speech or difficulty articulating, indicating that it is caused by inner ear imbalance, academically referred to as triggered episodic vestibular syndrome.
Typically, the role of medication is to alleviate symptoms, and with adequate rest and electrolyte replenishment, the condition will improve on its own.
It is recommended to avoid overexertion and maintain a regular schedule.
Blood pressure readings of 135/92 in the left arm and 140/95 in the right arm are normal; however, if the systolic blood pressure (the higher reading) between the two arms frequently differs by more than 20-30 mmHg, caution is warranted for potential severe vascular narrowing.

5-2.
If your previous neck ultrasound showed vascular narrowing, it is advisable to follow up annually to monitor for any worsening of the narrowing or changes in blood flow velocity.
It is recommended to discuss this thoroughly with a neurologist.

5-3.
This is a good sign, indicating that your dizziness is likely of peripheral origin.
The causes of dizziness can be broadly categorized into central and peripheral types.
Central dizziness is usually caused by issues in the brain, brainstem, cerebellum, or cervical spinal cord, while peripheral dizziness is caused by problems in the inner ear's vestibular and semicircular canal systems.
Therefore, central dizziness often accompanies other neurological symptoms, such as facial numbness or weakness, and abnormal sensations in the limbs.
Peripheral dizziness is often quite intense and may sometimes trigger autonomic nervous system responses, leading to symptoms like sweating and pallor.

5-4.
If you are genuinely concerned about potential abnormalities in the brain and feel that a thorough exclusion would provide peace of mind, you may consider self-paying for a head MRI or consulting with a health check center.
Costs vary by hospital, typically around NT$10,000 per session.
Wishing you health and safety.

Reply Date: 2020/02/26

More Info

Understanding the confusion between inner ear issues and hypertension can be quite complex, especially when a patient has a history of conditions like Meniere's disease and cardiovascular problems. Your situation is multifaceted, and it’s essential to address each component to provide a clearer understanding of your symptoms and their potential causes.

1. Meniere's Disease and Inner Ear Issues: Meniere's disease is characterized by episodes of vertigo, tinnitus (ringing in the ears), hearing loss, and a feeling of fullness in the ear. It is often associated with fluid imbalance in the inner ear. Your history of Meniere's disease suggests that you may have a predisposition to inner ear dysfunction, which can lead to symptoms like dizziness and tinnitus. The fact that you experienced a significant improvement after ten years of medication indicates that while the disease can be managed, it may not be entirely curable.

2. Cardiovascular Health: Your history of heart issues, including a heart attack and the placement of a stent, adds another layer of complexity. The symptoms of dizziness and lightheadedness you describe could be related to fluctuations in blood pressure, particularly if you are experiencing episodes of hypertension. High blood pressure can affect blood flow to the inner ear, potentially exacerbating symptoms related to Meniere's disease or causing new symptoms that mimic inner ear problems.

3. Dizziness and Position Changes: The dizziness you experience upon standing or moving your head could indicate a vestibular issue, which is often linked to inner ear problems. However, it can also be influenced by blood pressure changes. When you stand up or change positions, blood pressure can drop (orthostatic hypotension), leading to dizziness. This is particularly relevant given your fluctuating blood pressure readings. The fact that lying down alleviates your symptoms suggests that your body may be struggling to maintain adequate blood flow to the brain and inner ear when upright.

4. Tinnitus and Hearing Issues: The tinnitus in your right ear and the history of hearing problems in your left ear could be related to the inner ear's health. Tinnitus can arise from various sources, including inner ear damage, exposure to loud noises, or even stress. Given your anxiety about your health, stress could also be a contributing factor to your symptoms.

5. Management and Next Steps: It is crucial to continue monitoring your cardiovascular health while also addressing your inner ear symptoms. Regular follow-ups with both an ear, nose, and throat (ENT) specialist and a cardiologist are advisable. They can work together to determine if your symptoms are primarily due to inner ear dysfunction or if they are exacerbated by cardiovascular issues.

6. Lifestyle Modifications: You mentioned concerns about your weight and its impact on your health. Maintaining a healthy weight can significantly improve cardiovascular health and may help alleviate some of your symptoms. Regular exercise, a balanced diet, and stress management techniques can also be beneficial.

7. Further Evaluation: If your symptoms persist or worsen, further evaluation may be necessary. This could include imaging studies (like an MRI) to assess for any structural issues in the brain or inner ear, as well as vestibular testing to evaluate your balance and inner ear function.

In conclusion, the interplay between inner ear issues and hypertension is complex, and your symptoms may arise from a combination of both. It is essential to maintain open communication with your healthcare providers, ensuring that both your cardiovascular and ear health are adequately monitored and managed.

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