The Medical Consumer's Advocate
Another case of dizziness
following a strange illness
Q:
I am going to be seeing an
ENT at the --- Ear Clinic in May, but in the meantime, I
am going crazy trying to find an answer for my persistent
balance problem. It started on February X. I noticed when
I was in the computer chair or another kind of tipsy
chair we have that I felt my balance go off. The next day
I had chills, back ache and HORRIBLE headaches for about
4 days. OK, virus, I assumed, because a few other people
I knew had it too. The balance problem persisted, though.
It would creep up on me late in the day and not every
day.
I was treated for a sinus infection with Levaquin in
late March when I went to an allergist to get tested for
allergies (which I have suffered from for years, but
finally decided to do something about it). The same week
that I developed the balance problem, I was trying to do
60 crunches per night after not doing a whole heck of
alot of exercise for a few months. My neck was not
hurting though when the balance problems started.
Anyway, the antibiotic was for 2 weeks. The doc also
gave me some allergy meds to try like Claritin D, Allegra
D, Nasonex nasal spray. I tried them all. The Nasonex
every day for a week or so along with the Allegra or
Claritin. Allergies felt better, drip cleared up from
back of throat, headaches got better. Then I had a
physical, blood work, etc. Perfectly healthy, no thyroid,
anemia or diabetes detected from bloodwork. Blood
pressure great, cholesterol 163.
SO this persistent balance problem is driving me nuts
as I am perfectly healthy otherwise! I thought it was
gone a few weeks ago; for about 2 weeks, I only had 1 or
2 days with mild balance problem. I had really bad neck
and upper shoulder aches during this time for about 3
weeks. They would start around lunch time and wouldn't go
away until I went to bed and slept the night. That has
gone away. Balance problem persists. Now right ear feels
full off and on throughout the day. No tinnitus, no
hearing problems as far as I can tell. This is an allergy
time for me and I await my new prescription of Allegra in
the mail.
Any ideas on this?? Could I have done something when
I was doing all those crunches (sit ups) that would last
this long. And why does it seem to be every day all day.
It isn't there when I wake up in the morning, usually
starts after I have been up for an hour or so. I only
drink 1/2 cup of coffee per day and I tried to quit that,
but after 3 weeks of terrible headaches, I gave in and
started drinking my 1/2 cup again! Sorry to babble on.
PS, past history is mostly sinus, one to two infections
per year and I had palatal myoclonus about 9 years ago,
in my left ear.
A: I need to know the timing with regard to starting
Levaquin and the onset of your symptoms. Also, please try to
describe what you are feeling when you say "balance
problem".
Q: The problem started in the beginning of February.
I didn't start the Levaquin until mid-March. Symptoms
haven't really gotten worse until the last couple of
weeks when the off balance feeling is daily. It used to
be a few days in a row, then I would get a break for
sometimes up to 4 or 5 days, then it would come back a
day or two, and repeat.
I have read your dizziness article. I feel I must
call my problem "off balance" because that is
how I feel. If I move to quick I feel thrown off. But the
feeling of being unsteady is with me continually. It does
not appear to be like BPPV where it is just a short term
feeling of losing your balance. If I am not experiencing
the off balance feeling on a particular day, the quick
movements don't bother me.
Is Levaquin one of those antibiotics that can cause
dizziness? I have read about some, but I figured (1) why
would the doc give me that when I told him I felt I had a
sinus infection because of headache, a lot of post-nasal
drip (greenish-yellow) AND dizziness? and (2) why would a
doc give a patient something that causes dizziness? I
know it is a new drug, he told me that, but wouldn't the
side effects stop when you stopped taking the drug? I
have been off it now for about a month. I wonder about
all the other stuff I have tried. I have not gone a day
since all this started without either trying the Nasonex
a day or the Claritin or both or Sudafed, etc.
In your dizziness article, your description of
"lightheadedness" describes my feeling, almost
like I have had a few alcoholic drinks, but to me
lightheadedness would be that feeling you might get on
occasion when you get up too quick. That rarely happens
to me, but I know the feeling. Thanks in advance for your
input...
Have you ever heard of Meniere's starting out this
way? I have a friend of a friend with it and it sounds so
awful, I am worried I am headed that way. Thanks again
for your input.
A: Don't worry about Levaquin
(levofloxacin.) This class of antibiotics, for some patients,
will cause vertigo on the first and/or second dose. Not a big
problem, especially if your doctor forewarns you of the
possibility. This does NOT sound like your problem. Some
antibiotics can cause more permanent damage to the vestibular
(balance) system, but Levaquin is not one of them. So.. don't
worry any more about that one.
Also, don't worry about Meniere's
disease. Here's Meniere's disease, in a nutshell:
1. Whirling vertigo, lasting for
hours or even days, which occurs episodically. The vertigo
tends to resolve rapidly at the end of an "attack."
2. Accompanying the vertigo is
hearing loss. Usually one ear, but it can be both ears.
Hearing improves as the vertigo resolves.
3. Tinnitus (head noise), typically
described as "roaring", which occurs in the ear
that has the hearing loss, and which resolves as symptoms 1
and 2 resolve.
4. A sensation of pressure in the
ear. Once again, this resolves when the other symptoms
resolve.
This is "classic
Meniere's." We also recognize a few forms of
"atypical Meniere's," but your problem does not
sound like this. But more on this when I get a chance to
write again.
A: Well, let's talk about the
"crunch connection" for a bit before we talk about
what might actually be going on. The only form of dizziness
that I am aware of that is associated with straining (while
exercising, for example) is something called a perilymphatic
fistula. This is NOT what you have (I will explain why, in a
moment) but for the benefit of people who may be looking for
information on this problem, let me explain it a bit.
The inner ear, which is deep to the middle ear, is a
fluid-filled space. One of the fluids in this space is called
"perilymph." The middle ear is an air-filled space.
When one strains, perilymph pressure increases, and it is
theoretically possible to "spring a leak" of fluid
from the inner ear into the middle ear. The medical term for
leak is fistula, hence the term, "perilymph
fistula." Symptoms of a perilymph fistula are: sudden
vertigo (whirling dizziness), hearing loss in the relevant
ear, and possible tinnitus. These symptoms begin all at once
during the strain. Treatment is surgical.
I should mention that the diagnosis of perilymph fistula
following strain is extremely controversial, and many
well-respected ENTs do not believe this occurs (or at least,
it is an extreme rarity.) Perilymph fistula can
occur after ear surgery or head trauma, but this is another
matter entirely.
In any event, since you do not have true vertigo, have
experienced no hearing loss or tinnitus, then the
"crunches" are irrelevant.
So... I've spent a lot of time telling you what you don't
have, but what do you have? Let me summarize the
basics of what you have told me: the severe headaches
followed the onset of your lightheadedness; the headaches
resolved, but the lightheadedness persisted; you were
diagnosed with sinusitis the following month because of green
postnasal drainage and headaches (also, perhaps, because of
your history of sinusitis.)
Sinus headaches tend to be facial (the cheeks, brow,
bridge of the nose, and brows hurt) but occasionally the top
of the head or the back of the head may hurt. Typically,
sinus headache pain worsens when you are lying down or if you
put your head between your knees. Sinus pain tends to improve
after a hot shower.
One simple possibility is that you developed a sinus
infection at the beginning of February. In the beginning, the
sinus pain and postnasal drainage were not prominent enough
to dominate your attention, but the postnasal drainage led to
Eustachian tube dysfunction, which in turn caused your
unsteadiness. As the sinusitis evolved, the headache and
postnasal drainage became more prominent. Your unsteadiness
persisted because the Eustachian tube dysfunction persisted.
Advantage of this theory: it explains most of your
symptoms. Disadvantages of this theory: you did not describe
the typical "ear pressure" or "fullness"
that people with Eustachian tube dysfunction usually
describe, nor do you talk about your ears "popping"
or "needing to pop." Also, your lightheadedness did
not improve when your nasal symptoms improved.
Here is another theory. In early February, you may have
become infected with a virus that took up residence in your
balance nerve (a condition known as vestibular neuronitis.)
It is not uncommon for viruses to have multiple effects, e.g.
nasal congestion, sore throat, headache, and (in your case)
vestibular symptoms. (Not all cold and flu viruses are
created equal... if they were, we would have one cold and one
flu in our lives, develop immunity, and never have to put up
with that illness again.) It may be that the virus caused
enough nasal congestion to set you up for the sinusitis that
subsequently afflicted you.
Advantages of this theory: it explains why you have had
persistent balance problems, since recovery from such
illnesses can be very slow. It also explains your subsequent
sinusitis. Disadvantage of this theory: vestibular neuronitis
tends to wear off gradually; it does not come and go, as has
been the case with your balance symptoms.
So, as you might have expected, I am not going to give
you a pat diagnosis, but I hope I have put some of your
concerns to rest and that I have also given you some things
to discuss with your new ENT. Sounds like you are going to an
excellent place for ENT care. I wish you the best of luck--
let me know how things go.