Microvascular Compression

Hi doctor. Your presence here is most appreciated.

Here is my story: This summer, I had some troubles sleeping, walking up in the middle of the night due to strange feeling of noise in my head. Before summer, in May I had visited my ENT due to a sentation of fulliness in my left ear. Or that is what I thought it was. A strange sensation in the ears it was. The audiogram showed no serious drops acording to my ENT apart from a slight problem (drop in highs) in the right ear but he didn't give it much thought. Unfortunately, this audiogram is now missing, since he never gave it to me. Also, I had noticed a high pitched sound on occasions, during the day in silence, that didn't bothered me much. Did noticed also that I had less tolerance to noise.

The summer went on without real problems (during the day that is and most of nights). In September 12 however my real trouble begun: After having an incident of acoustic trauma (been exposed in a loud alarm for about 1 minute whithout covering my ears from the right side) my already existent non so much bothersome or aware of Tinnitus became much larger. I heard the noise all day, a high pitch noise like old CRT TVs (15500Hz) I couldn't sleep because of that, my hearing was strange, sound where distorted, especially high frequency sounds like a plastic bag, or even the letters "c","s" in phrases etc. High decibels noise is quite unbearable to me now. Due to my T razing its level accordingly to noise that is...

Immediately after the incident I took nothing for 4 days, thought it would go away by itself. Then I went to my ENT who through audiogram came to the conclusion I had a minor damage in the high frequencies 6000 and above. Unfortunately he hadn't got the previous audiogram to compare (said he gave it to me but actually he didn't). He prescribed corticoids (that was 5 days after the incident) orally 16 mg Medrol a day (small dosage don't you think?) and rebrain for the circulation. At the 9nth day, after no result came, I was hospitalized for 4 days with intravenous corticoids, oxinium for the circulation and neurobion. No results either. They did an MRI of the head and neck, they found nothing in the head but in the neck a few herinas. The sent me out to a neurosurgeon for this. Nothing came out of it of course, he said there is no connection and prescribed me physical therapy for the neck along with an anti-inflammatory drug which I didn't take. But I did do the physiotherapy (massage) which helped my sour neck a lot but not the tinnitus...

From then, I went to many Ents. They confronted me with the similar treatments, drugs to help circulation and vitamins. Most of them talked about acoustic trauma, some of them didn't mention a cause. One of them however had a different opinion: The last ENT I have been to, told me to do an MRI scan of the ears. Acoustic trauma was not the case because my audiogram didn't show a dent but gradual degradation in highs beyond 6000 Hz starting above 20 db (the reason why a/t was not the case according to this ENT). Of course, the audiogram didn't go beyond 8000 as all of the audiograms I have had.

The results from the ear MRI came as no surprise to my ENT: Microvascular compression in the right ear due to vasxular loop AICA annoying the VII and VIII C/N. My ENT prescribed me Neurontin (Gabapentin) for 3 months after trying to convince me to take a no pill road first. Of course the first option was not really an option for me after 2 and a half months of total craziness.

I take Neurontin for almost 3 weeks now, but with no results whatsoever. It may be too soon, but my case should not be considered chronic yet, so I simply cannot stay back and relax. Should I try a different medicine? I would even be willing to consider microvascular decompression surgery if I knew that would give me total or significant relief. But I am confused as to what the real problem is. Acoustic trauma, vascular compression or even both? Can anyone tell? Can there be some more exams I should take to reach a definite conclusion?

Thanks for your time Dr, wishing you all the best

 

Hi skoupidis -

The problem with vascular compression is that just because you have vascular compression and tinnitus, that does not mean the vascular compression caused the tinnitus. And to the best of my knowledge, there is no way of detecting ahead of time whether or not it is likely that microvascular decompression surgery for tinnitus (which, after all, is major surgery performed by a neurosurgeon) will result in eradication of or even diminution of the tinnitus itself.

Seems to me that even if your vascular loop plays a role in your tinnitus, it is a very small role. The real watershed event was your acoustic trauma.

Since it has only been a few weeks, there is still a very good chance that your tinnitus will just settle back down on its own. Nothing wrong with staying on the gabapentin for three months as prescribed by your doctor, but I don't think I'd do much more at this point than that save for trying to avoid the extremes, by which I mean trying to avoid very loud sounds in the environment and trying to avoid silence as well, both of which put strain on the auditory system. And resist the temptation to wear earplugs unless you know that you will definitely be exposed to very loud sound.

All the best -

Dr. Stephen Nagler