Inner ear / balance problem

[ianf]

I have suffered from a balance problem for 28 years - ever since contracting meningitis which has damaged the nerves of my inner ear, also causing some hearing loss at particular pitches. After the meningitis (which also partly paralysed an arm and shoulder movements) it took some 11 years before I got to ride a bike regularly again. One thing that I found was that I could no longer corner or descend with confidence forcing me to reassess what and how I was going to ride. These days I ride mainly time trials and the occasional circuit races where the bends are not too sharp. Cycling in the mountains (such as on Majorca or in the Alps) has caused me particular distress because I cannot cope with descending at speed or the angle of hairpin bends, I am now back on the track (Manchester) but still nervous on wheels. All I can say is that you are lucky that this is just a temporary condition and that you should exercise great care and patience and await your recovery. In my case it is permanent and I just have to live with the fact that I get shot out of the bunch on sharp/steep corners/bends and keep out of others' way so as not to be a danger to other people. Thank God for the time trial scene in the UK. At least I can ride alone and unpaced and not be too bothered about the time I lose on sharp bends.

Peter,

This may not be similar. But I have experience an Vertigo which cause my dizziness from 2000-2002 2weeks on and off. It took me 1 and half year to recover by seeing the ENT (ear, nose and tounge) specialist. After it stop finally got back on my bike and won the Dual Deaflympic Gold Medal here in Melbourne, 2005 January. But sudden 1 month ago i've fractured my skull, and now having ear balance trouble which sometimes i walk off the balance. Which I've never experience it. But I know what to do to get the result and see what can get fix. Simple see the ENT or Neurologist that could help you.

Regards
Reece-Emerson van Beek

 

[rockitj]

I have just been diagnosed, outof the blue, with an inner ear / vestibular virus that sees me hardly able to walk and spinning out if i try. It has totally derailed my rididng and I am very depressed as i have a lot of important events coming up. Has anyone out there had similar experiences and if so any suggestions for getting healthy quickly and if so how long were you off the bike ?

Thanks

Peter

I have Meniere's disease. I was diagnosed in 2001 and went through 1 1/2 years of hell, but am now in the best health of my life. Excuse me for such a long post, but this is a subject that has been life altering for me. When this started, I was 48 years old, obese, and a heavy smoker who did not exercise. Up until the final resolution in Jan. 2003, I was unable to work, or drive and was basically home bound. I never knew when an attack might occur, how long it would last, or how severe the symptoms would be. I have since quit smoking, lost 70 lbs., started riding a bike last July and now am riding about 175 miles a week and loving it. The four symptoms of Meniere’s disease are, vertigo, ringing in the ear (tinitus), slow loss of hearing in the affected ear, and a feeling of pressure or fullness in the ear. There is no cure for the disease, only management of the symptoms. It strikes randomly and it is not known why. If this is what you are feeling, I suggest you seek the absolute best medical care available to you.

Here's my story, I'm sure your circumstances will vary, but I hope it helps you. On the day after my son was married in Sept. 2001, when I awoke to go to work, I was dizzy and nauseous and couldn't walk. I suspected an ear infection and went to my doctor. Several courses of antibiotics failed to help and I was referred to a local ear specialist. After several weeks of treatment and process of elimination, his diagnosis was Meniere's disease. He prescribed Meclazine and vestibular rehabilitation, neither of which did anything to help. This doctor was pretty vague about the disease and having never heard of Meniere's, I went home and did a Google search on it. What I found and read scared the heck out of me. Thankfully, I live about an hour away from New Haven, CT and I went to Yale University Hospital for treatment. I was lucky to be treated by a world class Otologist there, Dr. John Kveton. A battery of sophisticated tests confirmed Meniere's. The one sure treatment is surgical removal of the inner ear. This stops all symptoms permanently, but obviously with complete deafness in that ear. Since my hearing loss was only moderate, Dr. Kveton wanted to try all other treatments and save the hearing in my affected ear, which he was able to do. Over the next year, I was given a series of increasingly invasive treatments to stop the vertigo. The first step in treatment was life style changes. Low sodium, no nicotine, caffeine or alcohol plus a steady low dosage of Valium to try to control the symptoms. This alone helps a percentage of people with the disease, but did not help me. In March of 2002, I had outpatient surgery to install a shunt (vent) in the inner ear cavity. Again this did not improve my condition. The next step in treatment was injections through the eardrum of an antibiotic that poisons and deadens the vestibular nerves. This worked temporarily for me, but the nerves regenerated and the symptoms returned. At this point I was in the 15 percentile that doesn't respond to any of the usual treatments. The only option left that would preserve my hearing was to surgically sever the vestibular nerve. This involves removing a half dollar size piece of skull behind the ear, moving the brain aside and severing the nerves and then closing the opening. I had this done in January of 2003 and it was a lifesaver, I have not had vertigo since and have the confidence that I won't again. My balance is not the best, especially in tight quarters, but it is adequate enough. While I was ill, I would walk as much as I could to get out of the house. I later progressed to jogging and then to bike riding because it is lower impact. I now lead a full life and live a healthy happy lifestyle. Good luck to you and I hope this helps.

 

[rule62]

Wow...what a story rockitj! That is a hell of a turn-around. Way to go!!!

 

[peterwright]

Thanks for the info and help guys - puts my problem into perspective for me.

I am being impatient as i want to get back to normal.

It will happen when it is ready.

Peter

 

[Otofreq]

Hi Otofreq

Thanks for taking the time to post.

I think that on balance it is likely that I had or have a virus and that vest neuronitis is the most likely diagnosis. My doubt lies in that the ENT could not confirm this due to insufficient nausea and an inability to show that any hearing deficiency was NOT there before I came to see her. On top of this my GP had me taking Stugeron and so i was medicated when I saw her.

I have been doing some of the exercises she gave me and have been exposing myself to general life activity such as work and driving and walking, in the hope that this will help my brain to re-adjust.

My reason for looking at the Chiropractic option (apart from the uncertain diagnosis above) is that I had a sore neck for 2 weeks leading up to the attack and I also had a heavy fall from my bike in jan/Feb this year and banged my head and neck. i felt that Chiro treatment might also help my recovery speed up by freeing up the neck ?

Please can you advise on what are the most effective exercises to finish the rehab process. I really feel I am at 80% and a little bit stuck there. Improvement is difficult to quantify now and progress seems very slow / plateaued. I want to be sure I am doing the right thing ?

Thanks for any help.

Peter

Peter,

There is some debate in our literature concerning this subject. However, at our lab,we make the following distinctions: With vestibular neuritis, one would not necessarily expect to see associated hearing loss. This is because the vestibular nerve is distinct from the sense organs of the cochlea and the auditory nerve (though vestibular and auditory branches comprise the 8th cranial nerve). Labyrinthitis frequently has hearing loss as an associated symptom. This is one way the two syndromes are differentiated.

I would refer you to the following web site for a comprehensive discussion of this condition. You will note that there is no mention of cervical involvement as a possible contributing factor. There is a reason for that which should become clear to you as you read the article. Also, note that neuronitis is usually a one time experience. The odds are that given time this problem will resolve naturally. Therapy, as I said before ,is a means to aid in the recovery.

http://www.dizziness-and-balance.com/disorders/unilat/vneurit.html

Below is another site that discusses cervical vertigo. You will see that there is much contraversy on this subject too. I would consider cervical vertigo as a possible factor given your reported head/neck injury. I concur with the article as it does advise extreme caution in seeking chiropractic treatment of this condition.

http://www.dizziness-and-balance.com/disorders/central/cervical.html

As regards your request for effective exercises; I am not expert in vestibular therapy. As an audiologist, I am most involved with the diagnostic side of balance disorders. A physical or occupational therapist with special (advanced) training in treatment of balance disorders is the person you want to ask.

 

[Otofreq]

I have had a simular problem for years. It comes and goes without warning. My doctors keep saying it is a virus, but offer no solution but an over-the-counter drug known as Meclizine. One doctor told me "The good news is these things usually burn themselves out; the bad news is they usually take your hearing when they do." My symtoms include vetigo, loss of balance, and sudden loss of hearing in one ear. If anyone has a real solution, I would like to hear it. It's a pain in the ass.

I would question the diagnosis of virus. It is unlikely that a virus comes and goes as you report. I believe your physician was suggesting a diagnosis of Meniere's desease.

If you research the literature on this disease, you will find that long term use of Meclizine is not indicated. Rather, a diurectic and low sodium diet is most often prescribed. I would consult with your physician about this.

 

[peterwright]

Hi all
Just an update for you all. I have been hammering my trainer for a few days now and attempted my first road ride agian on Monday this week - well I survived a two hour session..but it was an exhausting process due to the anxiety factor. I had not factored in how frightened I would be on a bike I used to feel so comfortable on. I then took a day off yesterday and then completed a 4 hour ride today on a very long straight road and once again am on my knees but stayed upright. Just like my body has adjusted to walking with this disequilibrium I am left with I am trying to get used to riding with it. I struggle with slow speed manoevres such as roundabouts or junctions where I have to look over my shoulder, also getting a bottle out and having a drink is a nightmare !

Anyway, I am working hard on rehab and i will get there at some point.

Cheers all.

Peter

 

[drserena]

Hi Peter,

"reaching for bottle is a nightmare".....at least you have your sense of humor. I completely know what you mean....I remember riding for so long on a mtn bike and using a camelback and then learning to roadride and reach for that little bottle on thin wheels....ahhhh!

 

[nerdag]

You could try the Epley Manoevre!!!

An Epley particle repositioning is only useful for benign paroxysmal positional vertigo - caused by particles in one's semicircular canals.

It won't do anything for viral neuronitis, which is an inflammatory condition.

As a medico in training myself, I wouldn't trust anybody to do an Epley's on me apart from a neurologist. I've seen one too many a GP stuff exacerbate BPPV because they weren't doing it properly.

nerdag.

 

[DocK]

An Epley particle repositioning is only useful for benign paroxysmal positional vertigo - caused by particles in one's semicircular canals.

It won't do anything for viral neuronitis, which is an inflammatory condition.

As a medico in training myself, I wouldn't trust anybody to do an Epley's on me apart from a neurologist. I've seen one too many a GP stuff exacerbate BPPV because they weren't doing it properly.

nerdag.

I have worked with some physical/physio therapists skilled in this technique. It all comes down to training and how often one performs the procedure.

 

[nerdag]

I have worked with some physical/physio therapists skilled in this technique. It all comes down to training and how often one performs the procedure.

Just to clarify, I'm not saying that anybody who isn't a neurologist can't be skilled in performing it. Like any procedure, there is a risk of complication, and although uncommon for a particle repositioning, it does happen.

BPPV is caused by calcium deposits at the base of one or more of the semi-circular canals in your ears. An Epley's repositions the particles so that they fall out of the canals.

An Epley's performed improperly, or performed on a person who is at significant risk of complication, may result in the stones falling into the base of another of the canals - and that can be a HUGE problem, with even worse vertigo.

One needs to know a little bit of neuroanatomy and neurophysiology (but need to know it relly well) to work out which canal it is in, and to be honest, I don't know of many people in health who are not in neurology who have that knowledge.

The reason is that being in a different canal, it requires a different set of movements to reposition the particles again.

I've seen one too many people attempt the procedure as instructed, only to have it backfire with no idea how to rectify it.

And then the compo suits start...

Just my $0.02 worth.

nerdag

 

[ladyclau]

Hello. I am from Colombia, computer Engineer. Yesterday I have my second Vestibular Neuronitis, the first was in Colombia almost 3 months ago. I am 40 years old, healthy, no problems at all. The thing is that my father has the same problem. Can you inheriting this illness ? And how you can fix this problem? Any diet ? My father went to the Doctor but they gave him some medicines and sent home when he can walk by himself. But he still have the dizzy, I need to help my father and me. Thanks and God bless you all.