Autonomic Nervous System Disorders: Symptoms and Insights

Suspected autonomic nervous system dysfunction?

Hello, doctor.
This year, I started experiencing sudden hearing loss, where it feels like my ears are blocked.
Within a few seconds, I can noticeably feel the surrounding sounds gradually diminishing, and it seems like I'm hearing through a membrane.
Although I can hear clearly, the sensation is very distinct, and at times, I can't hear anything at all.
Occasionally, this is accompanied by intense tinnitus, but the duration is also brief, lasting about 5 to 6 seconds or even shorter.
Both ears have experienced this, and it has occurred around five times this year.
I have visited an otolaryngologist, but no abnormalities were found.

Additionally, I occasionally experience sharp pain in the cranial area above my ears.
After confirming that there has been no recent trauma, any touching or poking in that area causes pain, and I also feel internal throbbing pain.
These symptoms do not seem typical of autonomic nervous system disorders, but I cannot identify the cause.

I have experienced more typical symptoms such as palpitations, frequent illusions of earthquakes, and often hear and feel my heart beating strongly before falling asleep.
After a military physical examination, I was diagnosed with sinus arrhythmia and left ventricular hypertrophy, but the doctor said it does not affect heart function.
I have also experienced hyperventilation, and I was sent to the emergency room twice due to severe episodes.
There have been several instances where my jaw or hands began to tingle, indicating a possible onset of an episode, which improved after I adjusted my breathing for a while.

Aside from the hearing issues, the other three symptoms have occurred intermittently over the past few years.
Although I suspected autonomic nervous system dysfunction early on, I did not take it seriously since it did not seem to be an acute major illness.
It wasn't until this year's unexplained hearing loss that I sought your advice.
If, after your assessment, you highly suspect that it is autonomic nervous system dysfunction that requires more attention, I plan to prioritize long-term treatment over my original plans.
Thank you again for taking the time to respond.

Chen, 20~29 year old female. Ask Date: 2023/07/07

Dr. Wu Enliang reply Psychiatry

Hello everyone, please fill out this self-assessment questionnaire: https://www.typc.mohw.gov.tw/?aid=52&pid=100&page_name=detail&iid=271.
If you have more than ten items, it may indicate autonomic nervous system dysregulation, or you may consider undergoing autonomic nervous system testing (Heart Rate Variability, HRV).
Dr.
Wu En-Liang.

Reply Date: 2023/07/07

More Info

Understanding autonomic nervous system (ANS) disorders is crucial, especially when symptoms manifest in various forms, such as sudden hearing loss, palpitations, and episodes of hyperventilation. Based on your description, it appears that you are experiencing a combination of auditory symptoms and autonomic dysregulation, which can indeed be interconnected.

The autonomic nervous system is divided into the sympathetic and parasympathetic systems, which regulate involuntary bodily functions, including heart rate, digestion, and respiratory rate. When there is a dysfunction in this system, it can lead to a variety of symptoms, including those you have described: palpitations, feelings of anxiety, and even episodes of hyperventilation.

Sudden Hearing Loss and Tinnitus
Your experience of sudden hearing loss accompanied by tinnitus (ringing in the ears) can be alarming. While you have consulted an ENT specialist and found no abnormalities, it is important to consider that auditory symptoms can sometimes be linked to autonomic dysfunction. The sensation of your ears feeling "plugged" or muffled, along with the transient nature of your hearing loss, could suggest a form of vestibular dysfunction or even a temporary disruption in blood flow to the inner ear, which can be influenced by autonomic regulation.

Palpitations and Hyperventilation
The palpitations you experience, particularly the sensation of your heart racing or pounding, are common in individuals with anxiety or autonomic dysregulation. This can be exacerbated by stress or panic attacks, leading to hyperventilation, which you mentioned has caused you to seek emergency care in the past. Hyperventilation can lead to a cascade of symptoms, including tingling in the extremities and jaw, which you have also noted. These symptoms arise from changes in carbon dioxide levels in the blood, which can affect nerve function and lead to sensations of numbness or tingling.

Potential Links to Autonomic Dysfunction
Given your history of sinus bradycardia and left ventricular hypertrophy, it is essential to monitor your heart health closely. While your doctors have indicated that these conditions do not currently impair heart function, they can still contribute to feelings of anxiety and autonomic instability. The perception of "earthquake-like" sensations could be related to anxiety or panic attacks, which are often tied to autonomic dysregulation.

Recommendations for Management
1. Comprehensive Evaluation: It may be beneficial to undergo a thorough evaluation by a neurologist or a specialist in autonomic disorders. Tests such as tilt-table testing can help assess how your autonomic nervous system responds to changes in posture and stress.

2. Lifestyle Modifications: Incorporating stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) can help mitigate anxiety and improve autonomic regulation. Regular physical activity can also enhance cardiovascular health and reduce symptoms.

3. Hydration and Nutrition: Ensuring adequate hydration and a balanced diet can support overall health and may help alleviate some symptoms associated with autonomic dysfunction.

4. Medication Review: If you are on any medications, it is worth discussing with your healthcare provider whether they could be contributing to your symptoms. Adjustments may be necessary to optimize your treatment plan.

5. Follow-Up with Specialists: Regular follow-ups with both your cardiologist and a mental health professional can provide a comprehensive approach to managing your symptoms. They can work together to ensure that both your physical and psychological health are being addressed.

In conclusion, while your symptoms may not fit neatly into a single diagnosis, they suggest a complex interplay between auditory issues and autonomic nervous system dysfunction. A multidisciplinary approach involving specialists in neurology, cardiology, and mental health will likely yield the best outcomes in managing your condition. It is essential to prioritize your health and seek ongoing support as you navigate these challenges.

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