- CASE FILE
11 week history of pulsatile tinnitus right ear; right ear/eye pain; pain and tingling back of head, vertigo
ABOUT THIS CASE FILE
For about 11 weeks I have been suffering with a pulsatile tinnitus in my right ear. About 2 weeks later, I suddenly began experiencing severe right ear pain and less intense right eye pain. In about another 3 weeks, I suddenly started having issues with episodes of vertigo and pain/pressure along the back of my head which were progressive over 2 days (this required a trip to the ER due to the severity of the pain and vertigo - they recommended I see a neurologist). In general, the pain seems to be worse when laying down and in general it seems the vertigo worsens with activity. I have seen ENT Dr (twice) - ear exam is normal, hearing test is normal, sinuses were scoped and were normal. MRA/MRV and MRI (with and without contrast) are all unremarkable. BP is normal. Lyme is negative, thyroid level is normal and bloodwork evaluated by my rheumatologist reveal no new abnormalities (chronically low C3 and C4); the ESR and C reactive protein are normal. I was advised by my neurologist to see an ophthalmologist to rule out papilledema (concern for idiopathic intracranial hypertension) - the eye exam was normal. The next diagnostic test to pursue is a lumbar puncture - I have not had that done yet. Currently, basic rule outs being considered include an immune mediated cause (eg related to lupus), a possible infectious cause given long history of immunosuppression or an atypical presentation of a vestibular migraine.
In addition to my usual medications for the auto immune diseases (methotrexate, plaquenil) and other meds (eg 81 mg aspirin, thyroid supplement), I have only taken ibuprofen for the pain and meclizine as needed for the vertigo signs.
This has been a very frustrating and difficult time. The symptoms tend to wax and wane without predictability, though generally they get worse if I try to do more. However, even when they are less intense, they never completely subside and it is exhausting. I work full time and when the vertigo is bad enough, I have been getting rides to and from work to not miss time there. With my history, I am no stranger to fatigue and pain; however, I am honestly just looking for a reasonable explanation for these symptoms. I am so tired of this and am in dire need of relief.