I had a client this week who complained of Depression, Anxiety, Fatigue, Headache and bouts of extreme anger and rage. He is a 50 year old male, smoker, moderate drinker. Complains of occasionally "hearing bells ringing" and experiencing rotational vertigo as well. Family history of Schizophrenia and drug addictions. Client denies drug use. Easy diagnosis for me, and a medical exam confirmed my suspicions. What thinks ye, mighty web MD? Barry
Tiinitus and rotational vertigo are extremely nonspecific symptoms. You haven't given me any meds or really any kind of history that would allow a "diagnosis". Anyway just playing along migraine headaches are a common cause of vertigo.
You are leaving out the issues of depression, and rage behaviors. He also experienced "Otolithic crisis of Tumarkin". He has a condition that is often seen in community mental health, although the illness is medical, not mental. Care to guess again? Barry
A crazy high number of the of the population reports having ringing in the ears (10-15% and 85% of those with anykind of ear problem). As far as vertigo it is similarly nonspecific for any one disease and can in fact be from many different kinds of disease. It is possible to come up with a differential diagnosis but you are not giving a true history which follows a specific format and addresses certain criteria and includes a physical exam. Areas that should be covered include chief complaint, history of presenting illness, family history, social history, psychiatric history, past surgeries, meds, drug allergies, review of systems, physical exam culminating with a differential diagnosis and assessment and plan. For example a finding or history of nystagmus would have been helpful as part of the physical exam or history of presenting illness for IDing Ménière Disease. Also, many times their is a signifcant family history of the disease. Also possible onset with psychosocial stress is only one of several potential things that can precipitate an attack. Food allergies and irregular menstrual cycles have also been associated with the disease. http://www.emedicine.com/ent/topic232.htm
With the interweb I can be an md too! There is no cure for Ménière's disease. However, the symptoms of the disease are often controlled successfully by reducing the body’s retention of fluids through dietary changes (such as a low-salt or salt-free diet and no caffeine or alcohol) or medication. Changes in medications that either control allergies or improve blood circulation in the inner ear may help. Eliminating tobacco use and reducing stress levels are more ways some people can lessen the severity of their symptoms. Different surgical procedures have been advocated for patients with persistent, debilitating vertigo from Ménière's disease. Labyrinthectomy (removal of the inner ear sense organ) can effectively control vertigo, but sacrifices hearing and is reserved for patients with nonfunctional hearing in the affected ear. Vestibular neurectomy, selectively severing a nerve from the affected inner ear organ, usually controls the vertigo while preserving hearing, but carries surgical risks. Recently, the administration of the ototoxic antibiotic, gentamycin directly into the middle ear space has gained popularity worldwide for the control of the vertigo of Ménière's disease.
