Some questions for Adam & everyone else

Hi Adam

I’m just coming off of another bout of dizziness. It seems to come and go in cycles again with no obvious triggers. Therefore, I have some questions and comments to put foward:

  • I used to belive that it was lack of sleep and being generally run down that causes relapses however; last night I was awake most of the night suffering with hayfever. I then had to get up and go to work with little or no sleep yet I have no dizziness today. Other days I have the dizziness after having a good night’s sleep.

  • Could stress be a factor?

  • I thought alcohol might be a factor but once again, I’ve had night’s on the booze and no dizziness the next day.

  • Is the pizotifen doing anything given that the symtoms come and go whether I’m on it or not. Or does the drug kick in better long term?

I have discovered one thing though; When I blow my nose hard it brings on the dizziness big time, which has me wondering if the cause was somehow brought on by excessive ‘hard’ blowing (as I’m a sinus/hayfever sufferer). Is it possible to do some damage from blowing hard with a blocked nose?



Hi Tibor

Any of the above could be factors, it can be hard to determine what are your specific triggers but keeping a
diary can help. Oversleeping and undersleeping make a huge difference to my symptoms to me personally.

If you are having dizziness when blowing your nose (actual vertigo) you need to see a neurotologist. The ‘fistula test’
which tests for a perilymphatic fistula is done by holding your nose and blowing. This brings on vertigo in those
with a perilymphatic fistula. You might want to do a Google search on this for more info.

If you taper off the Pizotifen, and your symptoms get worse you will know that it is working. I’ve had this problem
myself where I thought the Pizotifen was doing nothing, and then went off it and realised just how bad the dizziness
was before I started the drug. It doesn’t always eliminate it, often it just gets better. From what I remember you are still
on a low to normal dose so you might be able to get further improvement with a higher dose. It’s really trial and error
and the process of getting things right can take a long time.

If you are starting and stopping it at the moment, you may not improve. You have to stay on the drug consistently and
take it consistently. Even missing doses may greatly reduce its effectiveness.

Hope you feel better soon.


Hi again Adam

Thanks for your input. I tried holding my nose and blowing and yes, it does make me dizzy! I’m going to research perilymphatic fistula and see what comes out of it, if it looks like my symtoms, I’ll go see a neurotologist.

I’ve still been taking the Pizotifen through all of this, 2 a night without stopping so I’ll see what the neurotologist says if and when I see one.

Thanks again


If you do have a fistula (it sounds likely…) they are usually repaired surgically.

It is quite possible to have both MAV and a fistula - it would be hard to recover from
one while another was intefering also.

Let me know what you find.


Thanks Adam

I did a bit of research on Fistula, wouldn’t this have been picked up on my CT and MRI scans? Also, what does a neurotologist do that a ENT doesn’t?



A CT scan or MRI won’t show a fistula or indeed any inner ear problems other than
structural abnormalities of the temporal bone (which is called Superior Canal Dehiscence syndrome). This is rare.
But CT/MRI will also exclude brain tumours, blood circulation abnormalities etc.

ENTs have traditionally been the doctor you go to with ear-related problems but vertigo/dizziness has proven
to have a much wider scope than previously thought. Neurotologists focus ENTIRELY on the vestibular system (including
the central vestibular system - in the brain) and nothing else - very specialised. You will find, for example, that ENTs
do not diagnose migraine-associated vertigo. One of the world’s best neurotologists is in Sydney - Dr GM Halmagyi - he
once said in a lecture that a friend of mine attended that ENTs like easy problems where the solution is to cut something
out. After being butchered by an ENT myself (who blamed sinusitis for my chronic dizziness), I would never see one for
dizziness/vertigo/inner ear related problems.


Thanks alot Adam

One more question; How does the neurotologist test for a fistula?



This could also be positive for a dehisence of the semicircular canal. This would be picked up on a cat scan. It is also sound induced with this condition. Do a search for Dr Minor at Johns Hopkins and you can read about it. He was the one who discovered it. They do a patch to plug the missing bone.


Thanks for the good info Charisse.

I was only just reading about this the other day - this article mentioned Dr Minor … uery_hl=10

Hi Everyone,

This has been a fascinating string of posts!

As for myself, my vertigo bouts can occur after a disruption in usual sleep patterns. But not always. Stress DEFINITELY can bring on a bout of vertigo lasting five to six hours. The vertigo usually occurs a few days after the stressful event. Sometimes I feel oddly fatigued a few days prior and a little off balance before the actual attack. I sleep Bigtime. Gradually the vertigo goes away.

Well, maybe it all has to do with Body Chemistries-------something – some chemical – builds up and then Ka-Pow. :stuck_out_tongue: