General Question

mirifique's avatar

Otolaryngologist or neurologist?

Asked by mirifique (1511 points ) January 31st, 2010

I’ve recently been feeling a headache-type sensation in what feels like the center of my head, or at the tips of my ear canals – a semi-sharp sensation, not necessarily pain but definitely not comfortable; I suppose it is similar to a tension headache. I think it’s due to playing music over the past month (singing, wearing monitor headphones for long intervals, etc.—yes I know this is bad). My other symptoms include a sensation of confusion from time to time which lasts 3–4 seconds, and generally feeling like I’m in a brain fog. I don’t want to waste time or money getting various referrals so I’m wondering if I should see a neurologist or go back to my otolaryngologist, who I had seen for BPPV (benign positional paroxysmal vertigo). After hours of googling my symptoms I can’t find anything bearing resemblance. Maybe I’m slowly losing my hearing? God I hope not. I’m a musician. Or brain cancer? Anyone with any insights?

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20 Answers

shilolo's avatar

I’d vote for the neurologist. They have a more general training/expertise in neurologic problems, and the “sensation of confusion” issue is more worrisome, along with the headache. Most likely, both would consider ordering a CT scan or MRI if the symptoms sounded severe enough, but a neurologist would be better suited to do a more thorough initial evaluation. Just so you know, brain tumors are rather rare, so, although people do worry about them, the chances are low. All of this could be related to your music career, as you suspect, and you might benefit from a formal hearing evaluation as well.

DrMC's avatar

Actually the most cost effective approach is to give further history to a good primary care physician. Internal medicine primarily function to triage which tests and specialist to order.

I have constant ringing in my ears thanks to auditory damage. My ENT’s first question – wow, were you a drummer? (no – ipod and music and I sing). Enjoy your vocal cords, and ears while they last. I don’t care if I get ugly as I age – but sadly my voice is being ruined by the calender. Take care of your assets.

To analyze current details
headache – central (tension like) – ? non throbbing, new – possibly radiated to your ears

many questions you will be asked – pertaining to associated functions and adjacent structures.

The “brain fog” symptom needs to be detailed.

Is dizziness, mental unclarity, light headedeness?

Do you have sinus disease or symptoms?

Again, 15 seconds looking into your throat, ear canal and a few other things with about 20 questions more and the testing, and consults will be pinned by the average internist, possibly eliminating the need for a consult.

Any new headache could be nasty. There are not enough details given to give you odds however.

YARNLADY's avatar

The whole point of getting a referral from your doctor is because s/he can help you narrow down the specialist that best fits your needs.

randysdad's avatar

I would go back to the Oto as he already knows your history and will be able to help the Neuro know where to start. Looks like an MRI or CT Scan are coming up soon.

The_Idler's avatar

Where do you live?

Do Americans have to pay, every time they have a health concern they wish to discuss with their GP? Is this why you do not simply ask them for a once-over and a referral?

That would be terrible, how much does a normal appointment cost?

FireMadeFlesh's avatar

I would first see a GP, and ask for a referral to a neurologist. The neurologist will likely order a CT or MRI, which will probably be the most valuable diagnostic information. (On a side note, if you are under 35–40 years of age, insist on an MRI rather than a CT. If you are over 40, it doesn’t matter as much).

Do not try to self-diagnose with Google; that is just asking for trouble. See the people qualified to make a diagnosis, and see what they come up with. You haven’t listed enough symptoms to really point to a particular problem yet.

DrC's avatar

An MRI will show what is happening at the level of the sphenoid bone – nerves going to the ears as well as the base of the brain. CT can’t show this because the bone distorts the signal in that area. Are you actually having pain? I think a neurologist that specializes in headaches would be the way to go.

snowberry's avatar

If a physical exam rules out the obvious (as suggested above), t sounds to me like you could stand to see a Chiropractic Neurologist. If my doctor were to see you, he might say you over-stimulated certain areas of your brain. The brain can only handle such over-stimulation for short periods of time. If it gets too much too fast, because of the over-stimulation in one area, other areas shut down, which sounds like what you have done.

When the brain stops sending signals to the body, eventually you start to see physical evidence of that, and vice-versa. The brain and body then try to compensate for the imbalance, which always ends up being different than we like. Here is a (very long) article that much more thoroughly explains what’s going on than I have room or ability to do here. http://findarticles.com/p/articles/mi_qa3841/is_200006/ai_n8910193/

I myself received tremendous help when I went. It basically gave me a life, and for the first time I am experiencing life like other people do. You can go to the Chiropractic Neurology Board to see if there’s a doctor in your area. Here is that link. Click on “Doctor Finder on the left column and you’ll see how close you are to one. http://www.acnb.org/index.html You can also go to Youtube and type in Chiropractic Neurology and find a number of

Dr_Dredd's avatar

Agree with @DrMC (and not just because I’m a primary care doctor. :-))

No offense against chiropractors, but I think you should see an M.D. This is something that is beyond their level of expertise.

shilolo's avatar

@Dr_Dredd Why no offense? Chiropractic is BS, and you know it.

The_Idler's avatar

Chiropractic Neurology? What a pile of bullshit.
Stick to massaging the cramp i mean cash out of over-enthusiastic i mean gullible wankers.

I’d hate to see someone die from a serious brain complication, after spending hundreds on having some guy flash multi-coloured lights in their eyes and stick little pins in their shoulders whilst playing them soothing music.

Dr_Dredd's avatar

@shilolo I know. It’s just too early in the morning to start up a shit-storm…

gailcalled's avatar

My hotshot ENT surgeon has a giant magnifier for looking inside the ear, but relies on a tuning fork for confirmation.

Rarebear's avatar

Go to a good family physician.

gailcalled's avatar

I had several (unsuccessful) surgeries to try to replace a broken stapes bone (from a bad fall I took)with a titanium prosthesis. I was able to tell the surgeries were flops from lack of hearing inprovement in left ear.

Surgeon confirmed by hitting a tuning fork until it hummed; he then placed in on my mid-forehead, just below the hairline. I was able to tell him where I heard the sound (conductivity.) He was able to confirm my diagnosis of 0 improvement.

shilolo's avatar

@gailcalled That’s an old and standard test known as the Weber test that all medical students learn and (have to) use. Thus, I used to carry around tuning forks in my white coat. Now, not so much.

Dr_Dredd's avatar

@shilolo Don’t forget the Rinne test. :-)

gailcalled's avatar

@Doctors: This guy always had a retinue of interns trailing him around and he use the Weber test (on me) as a teaching device. He also recited spondees behind my head to see whether my hearing had improved. (Ice cream, baseball, words with equal stress on two syllables. We ended up discussing poetry rather than my hearing issues.)

snowberry's avatar

Just because you’ve never heard of something doesn’t mean it’s not true. I’ve spent my entire life (I’m 55) going from one doctor to the next, spending thousands of $ looking for an answer to my problems, but none of them had a clue. However, they certainly were willing to take my money.

FINALLY I did find someone who does get it, who explained what was going on with me BEFORE he took my money, and how he planned to fix it (Wow, now there’s a new concept)!. It’s a full on Chiropractor with a full complement of Neurology classes to boot. I spent about an hour and a half 3 times a week for a few months going to this doctor. I had several different kinds of therapy (auditory, eye and physical), along with chiropractic adjustments each time.

I was not sure what to expect at first, but soon I was amazed, because the doctor would adjust my neck, and I’d feel like I had put on glasses! Now I am able to do things I have never been able to do before. For the first time in my life, I can catch a ball (I had problems tracking moving things with my eyes), stand still with my eyes closed without having to move my feet to keep from falling over, and a lot of other things like that. I have met people now fully recovered from a variety of brain dysfunctions due to accidents, strokes, or as in my case-from birth, and it is real.

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