Possible Meniere’s - must disclose

[Wright]

About 9 months ago I complained to my PCP that I had pressure in my left ear during a routine physical. I told him I suspected it was a cold.. He looked at my ear and confirmed I had signs of pressure/congestion.


About 6 months ago, still feeling the pressure – I suddenly got dizzy and laid down. It passed in 45 minutes, but it was pretty severe at the time. Saw another PCP at the same office. I told her I was experiencing ringing in my ears, a constant feeling of pressure in the left ear, and difficulty clearing my ears where I was feeling a 150 foot elevation gain in an elevator. She told me to take two over the counter medicines (Flonase and Claritin) to clear up my ears – as she felt that sometimes this congestion is real hard to clear out. I should only see an ENT if it did not clear in a month, or if it got a lot worse.


About 3 months ago I went to Mexico for vacation and on the 3rd day I had another dizzy episode, but this one lasted all day, and came with symptoms that included vomit, the world spinning, etc. However, other people on the trip got sick from eating the food, so I did not know if it was food sickness or related to my ears. I could argue either theory.


My PCP scheduled a visit with an ENT. I visited the ENT and he said that there were no abnormal signs from physical exam, and I had perfect hearing at all frequencies from a full hearing test conducted that day – but he had some concern about possibility of Meniere’s. He told me to come back for another hearing test if I woke up one morning and felt muffled hearing. For better or worse, because I wanted to get healthy and did not think about the ramifications of a paper trail, I told the doctor my life story and he wrote it all down, so the medical record will be very detailed.


He scheduled me for a battery of balance tests that would diagnose the Meniere’s and check my balance. However, I finally was able to clear my ears and most of the symptoms went away. So, I cancelled the tests because if I was going to spend >$500 to check my personal balance, before I reduced my bank balance, I wanted to do it when I was symptomatic (thinking, perhaps falsely, that you don’t call the plumber when your toilet flushes fine).


I have ridden in unpressurized planes to 18,000 MSL as recently as 2 days ago, with a freefall decent (a.k.a. skydiving), and I am able to clear my ears, something I could not do when the symptoms were real bad a few months ago. A few months ago flying in a pressurized commercial plane (8,000 feet-ish of pressure change) caused extreme pain.


So now I am faced with the fact I have to disclose vertigo/dizzy on the FAA form + disclose a trip to an ENT where his medical records will reflect favorable hearing test results but the negative note about recommended testing for Meniere’s


I am plagued with a bunch of legitimate questions and concerns:

1) I still have some ringing in the ears, but 20% of all humans do. So, this could be coincidental or a sign of a Meniere’s symptom.

2) I cannot 100% say that the feeling of pressure in my ears is 100% gone. But I can say it is much-much-much better. Since it has me nervous now, I am hyper-sensitive

3) I KNOW I had sinus congestion – I saw the stuff coming out of my nose. That can cause vertigo and pain/pressure. So I have a reasonable “excuse” for the issues.

4) I did not do the recommended tests for Meniere’s, but my reasons were legitimate as the majority of the symptoms cleared. However, since I did (and still do) have some of the signs, it cannot be ruled out without additional tests.

5) The episodes were recent, so we cannot just say it was a fluke in the past. Meniere's can have up to a year remission (as can the common cold, hahahaha)

6) If I do the tests, and they come back positive, does this ground me for life – even if I am in a long period of remission? If I do the tests and they come back negative, will the FAA/DME accept the findings?

7) Ironically, if it is Meniere’s, as the disease progresses the vertigo incidents tend to subside but hearing loss increases… So, the most dangerous time, should the disease follow a normal path, would be on the onset. So, if I was diagnosed officially, there may be a time in the future where the dizzy spells are a thing of the past.


B.T.W. I understand that ultimately it is my responsibility to self-ground myself outside of the FAA medical certificate issues, and those decisions weigh heavily on me… This post is more about navigating the paper trail I started, and determining when, if and how a doctor will be able to sign off without reservations.


Thoughts?

 

[lbfjrmd]

https://www.faa.gov/about/office_or...ide/app_process/exam_tech/item46/amd/vertigo/

report.

 

[Wright]

https://www.faa.gov/about/office_or...ide/app_process/exam_tech/item46/amd/vertigo/

report.

Yes, I saw that link... I agree it needs to be disclosed. The underlying question is 1) since it was not officially diagnosed, what will be the next steps? Going back to the ENT for the full tests? Reporting it as self-resolved? 2) What are the typical outcomes with reporting? The FAA has to make the decision it seems based on that link, but what decision do they typically make, has anyone else navigated a similar situation successfully? 3) If it is a false alarm, what do I do to put it to bed?

 

[lbfjrmd]

apply, report, await FAA instructions

 

[wilkersk]

Have you read about Benign Pyroxismal Positional Vertigo (BPPV)? I've been told its about the most common cause of vertigo, expecially in 50-something year old men. I have had a bout of it. It cleared up and went away. In fact, I had all the symptoms you describe. And, I went to an ENT specialist. He said I had BPPV, allergies and some high-frequency hearing loss. He prescribed an antihistamine.

At my next FAA medical, the AME wanted a letter from the ENT saying I'd had a follow up at 90 days and had not had a reoccurrence of vertigo. That's it, piece of cake!

Hope it turns out well for you. Don't be in a hurry to say its Meniere's.

 

[bbchien]

Have you read about Benign Pyroxismal Positional Vertigo (BPPV)? I've been told its about the most common cause of vertigo, expecially in 50-something year old men. I have had a bout of it. It cleared up and went away. In fact, I had all the symptoms you describe. And, I went to an ENT specialist. He said I had BPPV, allergies and some high-frequency hearing loss. He prescribed an antihistamine.

At my next FAA medical, the AME wanted a letter from the ENT saying I'd had a follow up at 90 days and had not had a reoccurrence of vertigo. That's it, piece of cake!

Hope it turns out well for you. Don't be in a hurry to say its Meniere's.

This is not BPPV.
No way. That's wishful thinking. there's enough of that in the intial post. The rationale that 20% of normal people have these symptoms- but not the constellation and history.

This needs reported. You are dancing on the head of a pin and every AME and every FAA reviewer is going to see right through it.

 

[bflynn]

Advice: Take a deep breath. Your health comes first.

Go get the test. At best, it will confirm that you’re just a hypochondriac and you can report the symptoms and a negative diagnosis. At worst, it will confirm that you have an inner ear problem and that may save your life. Or at least, make life better.

 

[Write]

This is not BPPV.
No way.

I agree.

However in a conversation with a friend who is a doctor he said that since the onset came in conjunction with a sinus congestion/cold, and the symptoms lasted until the sinus cleared, it could also be caused by the sinus issues and since resolved. So to focus back to the root question, (and the acknowledgment all along it must be reported based on the original thread title, and I plan to do so if I fly again) - there has been no official diagnosis at this time... if I go back and the ENT says the additional tests come back normal, then what? Cleared? Grounded because it is unexplained and enough symptoms matched? A reasonable waiting period and see what symptoms return if any? Or do I report it as an unknown cause and wait? Be proactive get the tests to get closure?

Thankfully this is not my livelihood, but it is something I enjoy and am young enough and otherwise in the best shape of my life, so I hate to see it go. But I understand this is a likely outcome. Just trying to figure out next steps, and what DMEs and the FAA have historically done or asked for in similar situations... None of my friends have experienced anything other than healthy exams so I am learning the steps. This might help me by saving money towards tests with no benefit. Or as my doctor friend brainstormed, perhaps wait 6 months to a year on the ground to get a better picture before taking additional steps...

I guess what I am trying to ask all along, as I wrap my mind around it:

1) if it was caused by the sinus infection, what kinds of tests would put this to bed? Or at this point are there too many symptoms so spending money on tests won’t help put it to bed and all outcomes likely will be grounded?

2) if the tests come back pointing to Ménière’s, and I go an extended period symptom free, is there any chance in the future that I could get a DME/FAA sign off, or is this pretty much the end of the road?

 

[azure]

Do you currently hold a 3rd class medical, or will this be your first FAA exam?

Either way, you need to put your health first. But once you have done that, and if your doctors are satisfied that your symptoms were a temporary thing, to return to flying your next best step depends on the answer to my first question.

The point being that if you have held a valid 3rd class since July 2006, you could go Basic Med. Vertigo/inner ear disturbances are not on the list of conditions that require a special issuance FAA medical before being eligible for Basic Med.

But you need to get your health situation sorted out first.

FWIW (and this is just a SGOTI impression as I am not a physician), your symptoms sound like they started from a middle ear issue like eustachian tube dysfunction, maybe from an upper respiratory infection. That, I should think, weighs against Meniere's, but again I'm no doctor and you really should follow up on this for your health's sake.

 

[bbchien]

I agree.

However in a conversation with a friend who is a doctor he said that since the onset came in conjunction with a sinus congestion/cold, and the symptoms lasted until the sinus cleared, it could also be caused by the sinus issues and since resolved. So to focus back to the root question, (and the acknowledgment all along it must be reported based on the original thread title, and I plan to do so if I fly again) - there has been no official diagnosis at this time... if I go back and the ENT says the additional tests come back normal, then what? Cleared? Grounded because it is unexplained and enough symptoms matched? A reasonable waiting period and see what symptoms return if any? Or do I report it as an unknown cause and wait? Be proactive get the tests to get closure?

Thankfully this is not my livelihood, but it is something I enjoy and am young enough and otherwise in the best shape of my life, so I hate to see it go. But I understand this is a likely outcome. Just trying to figure out next steps, and what DMEs and the FAA have historically done or asked for in similar situations... None of my friends have experienced anything other than healthy exams so I am learning the steps. This might help me by saving money towards tests with no benefit. Or as my doctor friend brainstormed, perhaps wait 6 months to a year on the ground to get a better picture before taking additional steps...

I guess what I am trying to ask all along, as I wrap my mind around it:

1) if it was caused by the sinus infection, what kinds of tests would put this to bed? Or at this point are there too many symptoms so spending money on tests won’t help put it to bed and all outcomes likely will be grounded?

2) if the tests come back pointing to Ménière’s, and I go an extended period symptom free, is there any chance in the future that I could get a DME/FAA sign off, or is this pretty much the end of the road?

Not end of the road. Get to an ENT for proper diagnosis and treatment. At one year with no episodes that whole year, pretty much meniere’s or not, can be certified.

If it was a non meniere’s viral vestibular disturbance, 90 days down is the minimum. But it is an error to not go see the ENT. If you wish to fly again you will be seeing him/her.
B

 

[Write]

Not end of the road. Get to an ENT for proper diagnosis and treatment. At one year with no episodes that whole year, pretty much meniere’s or not, can be certified.

If it was a non meniere’s viral vestibular disturbance, 90 days down is the minimum. But it is an error to not go see the ENT. If you wish to fly again you will be seeing him/her.
B

Perfect - thanks for the info, this is the info I was hoping to receive.

In the original post, it probably did sound like I cancelled the tests against the medical advice of the ENT, it was actually the opposite, I specifically asked and received the answer back that the best time was to take the tests when symptoms were active, and the week of the tests I had no symptoms, so we mutually agreed to wait... The hearing test however was required to get a baseline, and we did that, and I had good hearing... They replied waiting until symptoms returned was a reasonable thing, not required, but reasonable. Yes, cost was a factor, I wanted to spend the money when the best chances of getting accurate info were the highest. However I am going to go do the tests - already contacted them again yesterday....

Now, say some of them do come back positive - I have been reading that there are possibilities the FAA will approve, should some source of treatment (not medicine) put the disease in remission, but some of the articles are kind of old. In fact, I found an older post by you that said 6 months upped from 3? Can you outline the modern protocol if the test comes back positive?

Thanks for your time.

 

[RJM62]

Do you currently hold a 3rd class medical, or will this be your first FAA exam?

Either way, you need to put your health first. But once you have done that, and if your doctors are satisfied that your symptoms were a temporary thing, to return to flying your next best step depends on the answer to my first question.

The point being that if you have held a valid 3rd class since July 2006, you could go Basic Med. Vertigo/inner ear disturbances are not on the list of conditions that require a special issuance FAA medical before being eligible for Basic Med.

But you need to get your health situation sorted out first.

FWIW (and this is just a SGOTI impression as I am not a physician), your symptoms sound like they started from a middle ear issue like eustachian tube dysfunction, maybe from an upper respiratory infection. That, I should think, weighs against Meniere's, but again I'm no doctor and you really should follow up on this for your health's sake.

Meniere's was one of the diagnoses my ENT considered years ago after an unexplained unilateral hearing loss. That was after acoustic neuroma and all those other scary possibilities had been ruled out. But I didn't have the signature symptom -- vertigo -- so ultimately that was ruled out, too. The final non-diagnosis turned out to be something like "probable idiopathic Eustachian tube dysfunction" or something along those lines.

One possibility that's still neither confirmed nor ruled out is that it had something to do with a drill in GTMO when no one bothered to inform hands on deck that it would be a live-fire drill. A 5"/38 gun about five feet away can do some damage to an unprotected ear. The long interval of time between the exposure and the appearance of symptoms somewhat mitigates against that possibility, but the VA still keeps an eye on my ear (but again, without a definitive diagnosis).

What I've learned through all of this is that the craft of an ENT is not an exact science. I long ago lost track of how many tests the cadre of doctors who've examined my ear have done. These included squirting ice water in my ears, tossing my head from side to side like I was a bobble-head doll, blindfolded balance tests (not unlike roadside sobriety checks), STD tests, autoimmune assays, neurological tests, scans of every sort, and even a rabies titer test (apparently hearing loss is an occasional side-effect of the vaccine, which I'd had). And of course, literally dozens of hearing tests.

But still no definitive diagnosis.

It doesn't really bother me anymore because a Chinese pharmacist (who used to be a doctor in China) "prescribed" an herbal regimen once all the Western doctors had done their best. Along with restricting sodium intake, it pretty much eliminated the tinnitus and the "clogged" feeling, and dramatically improved my hearing. I've tweaked it over the years since the pharmacist retired and have it down to a handful of supplements, the specifics of which I'll keep to myself for the time being. OP needs to see an ENT, not SGOTI.

OP should not expect a rapid diagnosis, however. Unless things have changed drastically in the months since a doctor has examined my ears, diagnosing anything having to do with the ears or balance is, apparently, a very complex process.

Rich