Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
I am a 66 year old healthy male. I have tinnitus since two years. Magnetic resonance imaging (MRI) is normal except for age-related gray area. But of late, any outside sound like flushing toilet increases the volume of tinnitus. Left ear 6/10 and right ear 4/10. The sound is the insect cricket sound. Moreover, since two weeks, I have serious sleep problems. It happened after my exposure to music played by a bus in which I traveled for five hours. That night, the sleeping problems started. Further, as I complained stiff calf muscle and a bit of pins and needle in the legs, especially after sitting in the bathroom, a nerve conduction study was taken. Before that, a vestibular evoked myogenic potential (VEMP) test was done. Please give your opinion on those test results. Some local doctor yesterday suggested to take Niterest 0.5 mg tablet for sleeping and a relative who is a doctor suggested Melatonin 0.3 mg without any combination can be taken as it is also good for both sleep and tinnitus. Please kindly forward your opinion.
Hello,
Welcome to icliniq.com. I would like to know some details about your problem: 1. Do you have any hearing impairment from any ear? 2. Is there any watery/pus/other kind of discharge from any ear? 3. Is there any feeling of fullness in any ear or headache? Regarding sleep disturbance: 1. What problem do you feel in sleep? 2. Do you have difficulty in the initiation of sleep or have frequent awakening during sleep? 3. Do you feel sleepy during the daytime while doing your daily activities? 4. Do you snore while sleeping? 5. How is your day-to-day mood? 6. Are you taking any medication for tinnitus or for others? 7. What is your height and weight? As you mentioned that your magnetic resonance imaging (MRI) brain was normal, there may be a possibility that tinnitus could be related to some ear pathology. For tinnitus, I suggest you consult an ear, nose and throat (ENT) specialist.
Patient's Query
Hello doctor,
Thanks for your reply. The following are my responses to your queries. Regarding tinnitus, 1. The hearing is fine except very mild high pitch problem in the left ear. I recently passed a hearing test for driving. 2. No pain and no discharge in both ears. 3. No fullness in ears except once in a while while climbing on steep roads by car and no headache. Regarding my sleeping problems, 1. My current problem is the initiation of sleep. My eyes and body are begging for sleep but the initiation of sleep is not forthcoming. If I go to bed by 10.30 PM, I shall remain awake until 4 or 5 AM the following morning and go to sleep without my knowledge for five to six hours until 9 or 10 AM. This episode started early this month and continues. Yesterday, I retired to bed at 11 PM and I was rolling on the bed until 5 AM, that is, today morning and slept until 10 AM today. 2. As I am not sleeping well at night, I feel tiredness in the day time. Yet, my daily routine is not disturbed except for sensation of burning in eyes. 3. I do not snore. 4. My day-to-day mood is so far so good. I am not irritated. 5. I take fish oil 1300 mg of which 360 mg is Omega 3. One gel a day with meal during lunch. 6. Height 172 cms, weight 67.5 kg on average. I have attached the nerve conduction study and vestibular evoked myogenic potential (VEMP) test reports for your perusal. I am also trying to upload magnetic resonance imaging (MRI) images. Two months back, I underwent master check up and results are normal.
Hello,
Welcome back to icliniq.com. For tinnitus, I suggest consulting an ear, nose and throat (ENT) specialist. For sleep disturbance, you can try either Nitrest (Zolpidem), which is a good sleep inducer with minimal early morning sleepiness or Melatonin, which is helpful in maintaining the sleep-wake cycle. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. Along with that, I also suggest relooking at the sleeping environment. It must be cozy, comfortable, dark and a silent place without any external disturbance. Try to avoid having coffee, tea, cold drinks or hard drinks late in the evening and at night. Do some yoga or jogging early in the morning.
Patient's Query
Thank you doctor,
May I request you to suggest the dosage for Nitrest and Melatonin? Can I take both or only one? How many milligrams of each one? When to take them? What is your opinion on my reports that I sent to you? How long should I take the medicine?
Hello,
Welcome back to icliniq.com. I have seen the reports (attachment removed to protect patient identity). You can start with one of them (either of the two). You can start with 5 mg of Nitrest (Zolpidem) at bedtime or Melatonin 0.3 mg approx five to six hours prior to going to bed. Consult a specialist doctor, discuss with them, and take medications with their consent. If any new problem is felt, consult a doctor immediately. NCV (nerve conduction velocity) is grossly fine. The findings do not explain the symptoms.
Patient's Query
Thank you doctor,
I shall do so accordingly. What about the result of vestibular evoked myogenic potential (VEMP) test? Please let me know your opinion.
Hello,
Welcome to icliniq.com. For VEMP (vestibular evoked myogenic potential) and tinnitus, I suggest you consult ENT (ear, nose, and throat) specialist. He/she will be the best person to comment on it.
Patient's Query
Thank you doctor,
As advised, I shall show vestibular evoked myogenic potential (VEMP) reports to an Ear, nose and throat (ENT) doctor.
Hello,
Welcome back to icliniq.com. That is good. Keep me posted.
Patient's Query
Thank you doctor,
I have uploaded my magnetic resonance imaging (MRI) images for your opinion.
Hello,
Welcome back to icliniq.com. I have seen the images (attachment removed to protect patient identity). Your MRI (magentic resonance imaging) brain images are not showing any specific lesions which could explain your symptoms. Try to follow as advised and revert after two to three weeks for a follow-up.
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