OpenHealth Q&A

Should I Seek Further Evaluation? Insights from ENTs and Neurologists Needed

I’m a female, 60 years old, currently prescribed Effexor for Generalized Anxiety Disorder (GAD) and Crestor for cholesterol management, with no other medications or notable health concerns. My initial experience with severe spinning vertigo dates back to 2008. After consulting an ENT, I was diagnosed with Benign Paroxysmal Positional Vertigo (BPPV). Despite multiple episodes over the years, I managed with meclizine and learned to cope with the discomfort. In November 2024, I suddenly lost all hearing in my left ear. I returned to my ENT, who performed a hearing examination. Although my hearing had improved somewhat by that point, there was still evidence of low-frequency loss. He prescribed prednisone, which led to some recovery, but the issue persisted. That same year, I began experiencing frequent falls. One particularly alarming incident prompted a trip to urgent care, although luckily most occurrences did not lead to any injuries. Disturbingly, these falls happened without any preceding vertigo episodes, almost out of nowhere. Upon revisiting the ENT, I received a diagnosis of vestibular migraines. Following his advice, I tried to keep moving forward but began to feel a generalized unsteadiness, which was not typically tied to vertigo, despite occasional vertigo episodes still occurring. In July 2025, I experienced a further loss of hearing and returned to my ENT once again. He initiated another round of extensive tests, leading to a diagnosis of Meniere's disease and suggested a low-sodium diet as part of the treatment plan. I committed to the dietary changes despite the difficulties, though the relief was minimal. Upon reviewing my test results, I noted the 'Impressions' section outlined several important points: - Dizziness appears to be multifactorial, supported by findings such as a right-sided peripheral vestibular weakness from caloric irrigation tests. - Potential third window syndrome indicated in the right ear based on oVEMP results, suggesting further clinical evaluation is necessary to confirm or dismiss this condition. - The absence of cVEMP responses on both sides may suggest issues with bilateral saccular function or nerve performance, highlighting the need for additional assessment as age (50+) and the ability to maintain neck contractions could influence these results. - On the left side, no oVEMP responses could imply dysfunction involving the left-sided utricle and/or superior vestibular nerve. - Subclinical direction-changing nystagmus related to head positioning may point to central vestibular issues, warranting further investigation to understand the significance of these findings. While my ENT associated these results with Meniere's disease, he didn’t pursue further tests to explore the other potential issues mentioned in the report. To you, does this alignment of symptoms convincingly suggest Meniere's? Would you recommend seeking a second opinion from another specialist? I have found a neurotologist covered by my insurance—should I consult with him, a neurologist, a different ENT, or simply accept the Meniere's diagnosis and proceed? Any advice would be immensely appreciated.

Answers (1)

2/8/2026, 5:10:33 PM

OpenHealth AI

Based on your detailed history, it seems you're experiencing a complex combination of balance and hearing issues. Your recent symptoms have raised multiple concerns that warrant careful consideration. Here’s a breakdown of the salient points and what you might consider doing next.

Key Takeaways

1. You have a history of vertigo, hearing loss, and falls, which have culminated in a diagnosis of Meniere's disease.
2. Your test results indicate other potential issues that could be contributing to your symptoms, including vestibular weakness and possibly a third window syndrome.
3. It's important to explore these findings further to ensure an accurate diagnosis and effective treatment plan.

Explanation

Meniere's disease is characterized by episodic vertigo, hearing loss, tinnitus, and a sensation of fullness in the ear. However, your symptoms of unsteadiness, sudden falls, and the specific findings from your tests suggest that there could be other underlying issues at play. The mention of "third window syndrome" and central vestibular concerns implies that additional exploration could provide clarity.

Next Steps

1. Consult a Neurotologist: Given your complex vestibular history and the specific findings mentioned in your reports, seeing a neurotologist is a prudent next step. They specialize in inner ear disorders and will be able to consider all aspects of your condition more comprehensively.

2. Request a Comprehensive Assessment: During your visit, ask for a thorough review of not only the Meniere's diagnosis but also the implications of the other findings in your test results. It is reasonable to seek clarification on the necessity for additional testing related to third window syndrome and central vestibular issues.

3. Consider a Neurologist if Needed: If the neurotologist does not address specific neurological concerns and you continue to experience unexplained neurological symptoms (such as balance issues or headaches), it might be worth consulting a neurologist as well.

4. Keep a Symptom Journal: Document your symptoms, including how often you experience vertigo, unsteadiness, or any changes in hearing. This information can be invaluable for specialists when determining the best course of action.

5. Stay Engaged and Informed: Continue researching Meniere’s and related vestibular disorders. This knowledge will empower you during your discussions with healthcare providers.

Reassurance

It's completely understandable to feel uncertain and overwhelmed with these evolving symptoms. By seeking further evaluation from specialists who can provide a fresh perspective, you are taking proactive steps toward managing your health. Remember, you deserve thorough investigations and discussions about your symptoms, and there is no harm in seeking a second opinion when it comes to your well-being.