Tinnitus and Dizziness: Insights from Neurology

Q: Tinnitus and Dizziness: Insights from Neurology

Hello： Based on your description, the management of cardiovascular disease primarily involves controlling the three highs (hypertension, hyperlipidemia, and hyperglycemia), which you seem to have achieved. <br>However, you did not mention any sleep issues, so it may be worth cons

Tinnitus, dizziness?

Hello Dr.
Jiang, the following questions are for a patient (I actually have similar symptoms myself):
1.
Tinnitus, dizziness, and a sensation of noise in the head have been intermittent for 30 years (I am 56 years old this year).
2.
Recently, after 8 months of continuous dizziness, it has returned? (There was one clear episode of dizziness when moving, turning my head, or looking up or down, with the sensation coming from the back of my head.)
3.
The noise in my head has become louder recently, usually when I am fatigued or sleep-deprived.
4.
The neurologist prescribed Diphenhydramine, which sometimes helps and sometimes does not.
5.
During episodes of dizziness, it may be related to anxiety and overthinking; my blood pressure and pulse are usually elevated, accompanied by extreme nausea and occasional mild headaches on one side (including around the eye), but not necessarily the same side each time.
When symptoms occur, I can raise my arms to the sides without issue, stretch my arms out to touch my nose, read aloud, and even sing normally.
This particular symptom has been more frequent in the last three years!
6.
Additionally, my poor sitting posture often leads to soreness in the left trapezius muscle, occasionally causing very mild numbness in the left side of my face.
The last time, I even experienced numbness in the left upper arm tendon, left hip, back of the thigh, and calf tendon?
7.
Three years ago, I had a cervical ultrasound that indicated mild narrowing in one area of the intracranial space but was deemed not concerning (I take aspirin as prescribed by my cardiologist).
Regarding the fifth issue, I have expressed concern about a possible stroke during follow-up visits, but the neurologist firmly stated that no further tests are necessary and advised me to drink more water, adjust my mindset, and exercise regularly.
Each time I visit, he even pinches my belly and tells me to lose at least ten kilograms??? (My current BMI is 27).
The questions are as stated above.
I know that overthinking is unhelpful, but I still worry.
I have also consulted neurologists and neurosurgeons at the same hospital; after reviewing my previous cervical ultrasound report, they conducted physical examinations and reassured me that there is no cause for concern.
They mentioned that dizziness may improve with age but is unlikely to completely resolve, and suggested that if I am overly fixated on it, I might consider seeking help from a psychosomatic specialist.
I later followed their advice and consulted a traditional Chinese medicine practitioner, who surprisingly gave similar advice to that of the neurologist.

I apologize for the lengthy message, and I hope Dr.
Jiang can take the time to clarify my concerns.
Thank you!

Mr. Zhang, 50~59 year old female. Ask Date: 2020/09/11

Dr. Jiang Junyi reply Neurology

Hello: Based on your description, the management of cardiovascular disease primarily involves controlling the three highs (hypertension, hyperlipidemia, and hyperglycemia), which you seem to have achieved.
However, you did not mention any sleep issues, so it may be worth considering whether you have sleep apnea.
You mentioned that cervical ultrasound or transcranial ultrasound could not clarify intracranial vascular stenosis.
If you are concerned, you might consider arranging for a self-paid cerebral vascular MRI to rule out small vessel disease or intracranial vascular abnormalities.
I recommend that you consult with a sleep medicine specialist or a neurologist to discuss further evaluation and treatment.
Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2020/09/11

More Info

Tinnitus and dizziness are common symptoms that can significantly impact a person's quality of life. Understanding these symptoms requires a comprehensive approach, as they can arise from various underlying conditions. Based on the information provided, it appears that you have been experiencing these symptoms for an extended period, which can be distressing. Let's delve into the potential causes and management strategies for tinnitus and dizziness.

Understanding Tinnitus
Tinnitus is often described as a ringing, buzzing, or hissing sound in the ears that is not caused by an external source. It can be subjective, meaning that only the person experiencing it can hear the sound. The causes of tinnitus can vary widely and may include:
1. Hearing Loss: Age-related hearing loss (presbycusis) is a common cause of tinnitus. Damage to the hair cells in the inner ear can lead to auditory signals being misinterpreted by the brain, resulting in the perception of sound.

2. Noise Exposure: Prolonged exposure to loud noises can damage the auditory system, leading to tinnitus.

3. Ear Infections or Blockages: Conditions such as earwax buildup, middle ear infections, or Eustachian tube dysfunction can contribute to tinnitus.

4. Medications: Certain medications, particularly ototoxic drugs (those that can damage the ear), can cause or worsen tinnitus.

5. Underlying Health Conditions: Conditions such as Meniere's disease, acoustic neuroma, or vascular disorders can also lead to tinnitus.

Understanding Dizziness
Dizziness can manifest as a sensation of lightheadedness, unsteadiness, or vertigo (the feeling that you or your surroundings are spinning). The causes of dizziness are also diverse and can include:
1. Vestibular Disorders: Issues with the inner ear, such as benign paroxysmal positional vertigo (BPPV), Meniere's disease, or vestibular neuritis, can lead to dizziness.

2. Neurological Conditions: Conditions affecting the central nervous system, such as multiple sclerosis or migraines, can cause dizziness.

3. Cardiovascular Issues: Fluctuations in blood pressure, dehydration, or heart conditions can lead to dizziness.

4. Anxiety and Stress: Psychological factors can exacerbate feelings of dizziness, especially during episodes of anxiety or panic attacks.

Your Symptoms and Concerns
Given your long-standing history of tinnitus and dizziness, along with the recent exacerbation of symptoms, it's crucial to consider a few key points:
1. Duration and Fluctuation: The fact that your symptoms have persisted for 30 years, with episodes of exacerbation, suggests a chronic condition. It's essential to monitor any changes in the pattern or intensity of your symptoms.

2. Impact of Fatigue and Stress: You noted that your symptoms worsen with fatigue or lack of sleep. This correlation is significant, as stress and fatigue can amplify both tinnitus and dizziness. Implementing stress management techniques, such as mindfulness or relaxation exercises, may help alleviate symptoms.

3. Physical Examination and Imaging: It’s reassuring that multiple specialists have evaluated your condition and found no immediate concerns. However, if you continue to experience significant anxiety regarding potential underlying conditions like stroke, it may be worth discussing further imaging or evaluations with your healthcare provider.

4. Lifestyle Modifications: Your physician's recommendations regarding hydration, exercise, and weight management are essential. Maintaining a healthy lifestyle can improve overall well-being and potentially mitigate some symptoms.

5. Seeking Support: If anxiety about your symptoms becomes overwhelming, consider consulting a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing health anxiety.

Conclusion
In summary, tinnitus and dizziness can stem from various causes, and their management often requires a multifaceted approach. While it is understandable to feel anxious about your symptoms, it is crucial to focus on what you can control, such as lifestyle modifications and stress management. Continue to work closely with your healthcare providers to monitor your symptoms and explore treatment options that may provide relief. Remember, you are not alone in this journey, and support is available.

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