The Medical Consumer's Advocate
My head feels like it weighs about 200 pounds
Q: 
On and off for the past 10 years, I
have suffered with bouts of what my doctors diagnosed as
labyrinthritis. But all audiological testing I had in
1995 was normal, as was my hearing test a few months ago.
Some episodes would last two weeks, one a month, and this
time I have been out of work since January. And I am
desperate to get better. In these past eight months I
have been diagnosed with everything from MS, migraine,
and myofascial pain disorder and no one has helped me
yet.
Right now my head feels like it
weighs about 200 pounds and I can barely keep it up some
days. I am extremely sensitive to light, and hot, humid
weather. And I am totally off balance. My face is numb,
my head is numb. My teeth are sensitive to everything!
The list goes on and on. I have been diagnosed with
vasomotor rhinitis, several environmental allergies and a
sinus cat scan back in March showed fluid in my sinuses
as well as a concha bullosa and deviated septum. I have a
history of sinus headache with weather changes, and I'd
do anything to go back to those rather than what I feel
right now.
In April, my doctor's associate
found what she felt was one of the worst cases of TMJ she
has ever felt. The super-specialists I saw at a State
university hospital told me that there is no way that the
TMJ problem could cause this and prescribed Baclofen -
taking me off all my medications and having me cancel the
sinus surgery they felt to be unnecessary. And now I am a
mess...
Tell me Dr. Hoffman, do you
think someone like me with a TMJ problem combined with
several allergies and sinus problems could suffer the way
I am? I had an MRI of the brain and auditory canals that
came back normal. I also saw a neurologist who said that
she feels in no way are my problems neurological and also
described a terribly dysfunctional jaw. She said I should
wean off baclofen, get back to my allergist and
reschedule the sinus surgery which I am now doing.
I feel so horrible and hopeless
and don't know who to believe or to trust. I have always
told my doctors that it is so much worse after I chew,
how I hear crackling and get totally congested and
spinny. I cannot tolerate any changes in temperature -
like my ears are going to pop out of my head. I thought I
had my answer when we found TMJ - my cousin who is a
physical therapist told me about a little muscle that
works with the jaw to control the eustachian tube...but
now I have been torn in so many directions. These
"megadentists" told me that anyone who says TMJ
causes dizziness just wants my money and is a "witch
doctor". Who do I trust? I hate this day of HMOs
about as much as I'm sure the doctors do. I am only 29,
have a young child counting on me and I need to get
better. I am too darn young to be disabled! Any
thoughts??? I'd certainly welcome them about now. I don't
know if I can take another day of this!
A: Your symptoms could be due to a combination of
bad sinuses
and bad TMJ. Bad sinuses can cause ear symptoms (such as pressure,
lightheadedness, even vertigo) by causing Eustachian tube
dysfunction. The heavy head, sensitivity to weather, facial numbness and
teeth sensitivity really do suggest
sinusitis. (OF COURSE, I'm not sure you have sinusitis-- I am only going on
the information that you have given me, and sinusitis sounds like a very
reasonable hypothesis.)
TMJ does not cause dizziness. No way. Sinusitis can.
Here's the mechanism: nasty material from your sinuses (dead
bacteria, pus, etc.) drains down the back of your nose, right
by the openings of your Eustachian tubes. This inflames the
Eustachian tubes. The tissue lining the tubes swells,
narrowing the lumen (lumen = the open part of a tube), and
making it progressively more difficult for the Eustachian
tube to do its job. Its job is to ventilate the middle ear
space. If, due to inflammation, the Eustachian tube cannot do
its job, then the air within the middle ear space is trapped.
This air is gradually reabsorbed by the tissue that lines the
middle ear space, and a "negative pressure"
develops. There's no such thing as negative pressure, of
course; "negative pressure" merely means the air pressure
is LESS than ambient atmospheric pressure. This can cause a
wide range of symptoms, including ear pain, pressure, hearing
loss, tinnitus, and dizziness. (By the way, if your sinuses
are poorly ventilated, they can also develop air pressure
differences. As with middle ear "negative
pressure," the same problem in the sinuses can also
cause profound symptoms. This is one possible explanation for
your heavy-headed feeling.)
Now for an unfortunate dose of reality. Have I figured
out your problems? No way. With a little thought and effort,
I could generate a list of perhaps 6 to 10 other diagnoses
which could also explain your symptoms. Simply through human
nature and the natural limitations of email for this sort of
encounter, MY thought processes are naturally
"warped" by the small subset of information which
you have shared with me. I often worry that I am telling
people what they want to hear, not what is actually true. And
so, the simple fact of the situation is that you can only be
diagnosed by a physician who has examined you, "up close
and personal." But physicians are like anyone else...
there's good 'uns and bad 'uns.
Good luck, and don't give in to desperation.