Expert: Eric P. Wilkinson, MD - 10/31/2007

Question
QUESTION: I hope you can help me.  I am a 33 year old female who has been experiencing ringing in my ears and then I'll get real dizzy, now I've never passed out but I feel like I could. Then shortly after that I get a terrible headache.  Now I do get migraines at times, but these headaches aren't migraines, they're not that bad, they're bad, but not quite as bad as my migraines.  I can't understand why I've been getting like this. A couple months back, I went to the E N T complaining that my right ear was muffled and there was fluid coming out. But the E N T gave me Nasanex Nasal Spray and Allegra D, but that didn't really seem to help.  Would you have any ideas what to do next?  I had a CT Scan for the headaches but nothing showed up, but this ringing in the ears and feeling dizzy just started about a month or so ago.  Where do you suggest I go next?  Please help, I have 2 small children and I can't keep feeling like this.  Thank You,


ANSWER: How long do your dizzy spells last?  Do you have the ringing sound in the right ear?

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QUESTION: I answered your questions that you asked me about how long my dizzy spells last, and is the ringing in my right ear, and then I waited 3 days for a response, when you gave me my response for this, all you told me was that you already answered my questions, and you haven't answered anything.  All you did was ask me 2 questions, but you never told me what it could be or where to even go next.  I am at my wits end, and not sure what to do next. I think this was very rude and unprofessional. The answeres again to the questions that you asked were my dizzy spells don't last very long, 2 to 3 minutes at the most, but then shortly after, I get these terrible headaches. I also get Ocular Migraines, where I lose vision in my right eye, it's never my left eye. Do you think that the 2 could be connected somehow?  And I can't really tell which ear the ringing is coming from, but I do have problems with my right ear, that is the ear that is always muffled, and I also have fluid in this ear.

Answer
I thought I answered your question previously; I must have confused it with another question.

Your dizziness certainly could be migraine-associated vertigo.  This is a disease that has become much more understood in the past several years, and does not necessarily have to be associated with headache.  

You may need: 1) an MRI to rule out a problem with your balance nerve; 2) an audiogram if you have not had one previously to make sure that you do not have a unilateral hearing loss.  If those are negative, you may want to ask for a trial of migraine preventative medication; common agents are nortryptyline, amitryptyline, and calcium channel blockers such as nifedipine.  

The muffled sound in your right ear could indicate a hydrops condition, but if your hearing test did not show a low-frequency conductive hearing loss, it may be less likely.

You may want to consult with an ear specialist to put all of these things together and come up with a treatment plan.

Hope this helps.  Good luck!