Hey, John, I’m on 20mg Amitriptyline at the moment.
My logic for believing I have a lesion is this:
- My story all starts just over a year ago with some trauma to my ear. I’m really embarrassed to say but i tried to rid very compacted wax in my ear with slightly warm water from the shower - very stupid! Felt uncomfortable at time and within 20 minutes I started to feel dizzy! NB Doctors don’t believe this could be enough to damage inner ear (ear drum showed no sign of trauma) but perhaps I had a congenital weakness. In any case, the coincidence is very suspicious! My theory is the water may have caused the solid wax to punch the ear drum and transferred pressure punctured my inner ear. (Note how doctors also now say you should never get your ear syringed!) After this I had 4.5 weeks of severe imbalance and periodic nausea, but no auditory symptoms, which apparently cleared up, or for which I seemed to have fully compensated.
- Since that day, I often wake up with fluid in my ear which slightly muffles my hearing but usually clears once upright within a few seconds . It feels like the fluid is in my middle ear and the fact that it clears very quickly would kind of suggest that.
- Then had 5 months of no symptoms, returned to gym, went on holiday, took 4 flights, no issues except very occasionally a feeling of momentary dizziness whenever under great stress.
- Then, one day at the office, watching a projector, I had a sudden feeling of lightheadedness. 3 weeks later, tinnitus started. Imbalance and nausea returned. Went to see specialist. No historic hearing test to compare, but hearing test showed high frequency loss in bad ear.
- Imbalance and nausea subsided for weeks at a time, then returned, but soon became almost constant and migraine attacks started and worsened. Got MRI, clear.
- Since starting Amitriptyline, the migraines have all but gone, but I get short vertigo feelings that are combined with a feeling of fluid dripping in my ear. Imbalance generally fluctuates from almost fine to bad some days. I still get minor nausea some days, but mostly the amitriptyline keeps this at bay too.
So: Inner ear trauma caused or worsened an existing fistula which occasionally leaks into the ear. My imbalance is due to ear trying to equalise pressure. Later I get secondary hydrops which would explain the second phase and tinnitus.
I’m hopeful i’ll eventually heal but will take time. They say secondary hydrops can take a year to go once the cause has resolved. A neighbour of mine had trauma to his head and started to feel constant pressure in his ear and tinnitus. Two years later, the pressure has gone and his tinnitus has got much much better.
I note that Dr. Hain’s published conservative PLF treatment plan is exactly the same as migraine vertigo treatment. The assumption being the lesion heals, then the hydrops recede and that is that and no surgery is required. If it was just migraine all along, you are covered.
I should add, one ENT told me I may have a ‘bit of hydrops’ and told me this should improve with time. Having said all that I’ve only had the feeling of fullness once and it was intermittent and disappeared within an hour. My neuro is not yet convinced, but both agree on the Amitriptyline, I guess the only question is how much to control the symptoms? I’m still getting the occasional small sneak through migraines and periods of nausea.