Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Hubby can shut off the tinnitus

Forum: Neurology Forum
Topic: Traumatic Brain Injury


: : My husband hit his head on a tile floor, causing a lesion to his cerebellum confirmed by a positive ENG for right beating nystagmus, a perforated TMJ disc (MRI), and some kind of cochlear concussion. He had the following tests to locate the source of his problems: BAER, MRIs of Brain, Ear and TMJ, Fistula Test, ENG, SPECT. The remaining problems are slight truncal ataxia, and DEBILITATING tinnitus. One ENT said live with it, the neuro-otologist is suggesting exploratory surgery, the oral surgeon suggested open jaw surgery, and the neurosurgeon indicated that he may need microvascular decompression of the 8th cranial nerve. Which one should we pursue first? I suggested jaw, ear, brain because the jaw problem may fix everything, and the ear surgery comes with lots of risk. Also, is there such a thing as a traumatologist? He h has 10 doctors who all have their own idea as to what happened.


: Dear Sheila:

: What makes your husband's story interesting is that you mention that he can
: turn it off by manipulating his carotid artery. This leads me to think that
: the cause of his tinnitus is a arterio-venous fistula which he may have
: acquired from the trauma.

: I know that you say he has had a fistula test but too delineate this he will need to have an angiogram performed with
: both internal and external carotid artery injections.

: It also sounds like the many doctors that you have seen can not agree on
: a course of treatment and this may have to do with the fact that they arenot
: sure about the cause of his tinnitus. Without having the luxury of examining him
: and reviewing all the studies it would be difficult to give you proper advice.

: There may some merit to the idea of having a micro-vascular decompression
: but the reasons behind this must be proven beyond any doubt.

: If you wish to seek an opinion at the Cleveland Clinic, you may
: wish to call Dr. Joung Lee (head of skull base surgery) who has vast
: experience in performing MVD procedures. You may reach him at (216) 444-5670.

: Good Luck!

Thank you for the referral - I may act on it very soon. I have additional information and another question though - Hubby's SPECT came back with decreased blood flow to the left temporal and left frontal lobes. Could this be causing the tinnitus? He is also depressed. Regarding your comment about the angiogram: He did have an arterial angiogram, but I don't know if they did both internal and external carotid artery injections. I will look at the report. Is that routine?

The fistula test was done in his ear for a perilymphatic fistula.

Due to the many opinions, we have considered going to Mayo clinic for a team approach. Your opinion may hold water with Workers Comp - what do you think?

Dear Sheila:

All the other conditions that you describe surely contribute to his
condition but these are diagnoses of exclusion in that all other
posibilities have to be ruled out first. I am not sure about the Worker's
Comp issue as you will have to check on that yourself.

Best wishes for a speedy recovery!

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