VN is a aged diagnosis. It should actually be called ‘acute peripheral vestibulopathy’. There is no proof its caused by a virus, hence the rename, and in any case you have a clear history of two traumas to the ear, both an accident and surgery! A virus was surely not the cause of your problem? Such a diagnosis is in any case a gross simplification of the anatomy of the ear and what can actually go wrong. I’m also not sure i’ve heard anyone say they’ve had ‘vertigo’ from ‘VN’. Dizziness for sure, but vertigo?
The deficit of your ‘nerve’ may actually be a fluctuating deficit of your balance senses on that side in its entirety (ie not just the neurons). It makes much more sense to me that this is because of fluctuating fluid volumes that are in any case delicately balanced and very much upset if you cause injury to the ear. Expansion of the endolymph region of the inner ear would change the characteristics of your motion response and presumably reduce the number of hairs that have the space to work properly. The fact that one can feel better some days suggests that often little or no permanent damage is done to the actual sense and the condition would be reversible if the body to get a grip on the fluctuations of the fluids.
Your history imho completely fits - initial trauma then vertigo attacks, worsening vertigo attacks after surgery and subsequently poor balance and a lack of compensation going forward.
Secondary Hydrops is very likely because its well documented to occur after both physical trauma and also after surgery.
The reason its hard to compensate for a physical injury to the ear (a physical injury that might have been extremely minor btw) is that it upsets the fluid balance which then fluctuates. Secondary Hydrops is a condition where the endolymph region grows and shrinks (but presumably not as much as in Menieres). These changes can be picked up in your tinnitus - if your tinnitus is changing character every day, during the day, then its likely this is due to the plumbing, not your nerves (hypothesis is the hairs touch the ceiling of their channel that is constricted and are allowed to move again when released).
You probably get worse problems with a cold, not because you have additional viruses ‘attacking’ your nerves but because the force of coughing and sneezing is physically upsetting your inner ear, probably due to pressure transferred to the inner ear windows that in any case may be injured due to the Hydrops and potentially an initial fistula injury.
And here’s where we get to the limitation of a MAV diagnosis. Sure there are neurological symptoms and migraines as part of the symptom spectrum, but do not assume migraine is the cause - it is simply the result of the fluctuations of your vestibular response in that ear that the brain is finding hard to compensate to and so irritated by at times it can lead into a migraine.
There is no proof MAV is caused by migraine, that’s purely a hypothesis by some scientists, mostly neurologists btw! And you don’t just end up with a chronic migraine problem from nowhere!
Here’s a good thread to read and check out the first paper:
http://www.mvertigo.org/t/the-migraine-controversy/14216
ENT medicine tends to give stuff ‘categories’ and names just to have something to write down on paper. In reality they do not have the appropriate tools in the clinic yet to accurate determine root cause.
It makes me angry though - by calling MAV a ‘migraine’ condition its kind of letting the doctors off the hook! “Oh its migraine, nothing we can do”. That is total BS and we need to hope that many people are working very hard to work out therapies that can solve the root cause, not just give us meds that put the brain to sleep so we feel slightly better but turn us into zombies.
There is a new MRI test that can diagnose Hydrops, but presumably that will give you a static, not dynamic view over a period of days (in which they level could change). There is a test being developed in Japan for fistula, but that’s probably pointless because once you have vertigo attacks that is likely to be fluid entering the middle ear in any case to release inner ear pressure (the windows are very thin and probably evolved to release pressure), so establishing CSF fluid in your middle ear is at this point not very illuminating, you knew this would be the case anyway …
I suspect MAV is simply secondary hydrops which is fluctuating in extent, thus causing the brain a very hard time in compensation.
Secondary Hydrops can settle down spontaneously over time, especially if its caused by an injury. Some say it takes 1 to 2 years, but I suspect it could settle down over a much longer period.
http://vestibular.org/secondary-endolymphatic-hydrops-seh
Not just my humble opinion - I’ve done a lot of reading and analysis - but do please realise ENT medicine is pretty under-developed and mainly due to the lack of technology, but also because the inner ear is so well hidden under thick bone - its extremely hard to monitor, especially over time. Clinical MRI cannot visualise Hydrops or BPPV and hi-res CT scans cannot visualise soft tissue.
On top of all that there is a political element - there are camps involved and neurologists versus ENT’s who all see things very differently. What emerges is often a ‘dogma’. Years ago our conditions would have been called ‘menieres’ or ‘perilymph fistula’ and I think that would have been closer to the mark. However, ‘MAV’ clearly is not classic ‘menieres’ (no low frequency loss and no profound loss of hearing during vertigo attacks) and not as simple as a discrete ‘fistula’. I am at a loss to explain why MAV diagnosis has got traction though - secondary hydrops makes much more sense. It’s probably taken from the relative success of the medication - they assume because the medication helps its a migraine condition. That’s a pretty shallow reason. Of course there are neurological symptoms, and of course the meds help with those, doesn’t prove the root cause though!
Also I don’t know whether you noticed, on the treatment flowchart of perilymph fistula on Dr. Hains website I shared - a very illuminating instruction in the ‘iterated’ process - “avoid triggers, exhaust MAV/Menieres medical management”. That tells you all you need to know imho!
https://www.dizziness-and-balance.com/disorders/unilat/fistula.html
So yeah, by all means use the treatment protocol of MAV as that can be very effective, but let’s not delude ourselves that this condition is caused by migraine …
(And then comes the debate on why people get migraines in general … who knows, they may all be suffering from a problem in one of their vestibular sense organs!)