Possibly Meniere's Disease...how to proceed

Sam7

Sam7

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Sam
Hi everyone, new guy here. I just had an incredible flight experience this past weekend which has inspired me pursue my pilot's certification but I may have a problem that prevents me from flying.

Here is my situation: I get episodes of fairly intense vertigo. They last a few minutes, and usually occur 2-4 times in that specific day. Generally, I'm fine the next day. None of these episodes ever had any corresponding ear symptoms except for one of the last episodes I had which involved a loud ringing as well as my ear closing up alongside the vertigo.

Thankfully, these episodes RARELY happen. They happened several times throughout my teens and only a few times throughout my twenties. It's been nearly six years since the last time this happened, I'm now 32 years old. I've always taken exceptional care of my health and I've very vigorously physically active on a daily basis and I'm not on any medication.

A few years ago I took an interest in scuba diving and I'm aware that inner ear disorders are a disqualification for scuba. So I consulted with an ENT who also happened to be a scuba diver himself. I explained to him what I have explained above and he said I MIGHT have Meniere's Disease but since it happens with such low frequency, he didn't see the need to conduct any tests, give me medication, etc. and said it's not something I should worry about. He cleared me for diving and off I went.

Obviously one can't compare scuba diving with flying. Aside from deep sea diving, general scuba is fairly safe if you take all the proper precautions, educate yourself, and maintain calm should anything occur. You also usually have other divers around you. So just because I'm safe to dive, I don't feel it's necessarily the case with flying.

As such, I'm not sure how to proceed. From what I've written, does it sound like I have something serious and that I shouldn't even bother with flying? Should I consult another ENT and insist on getting some tests done? How would you all proceed?
 
My wife has Menieres, not a fun issue. It eventually will result in total hearing loss. Vertigo is an issue with flying obviously. My wife controls it with a very low salt diet and avoiding caffeine.

The vertigo she gets would be a big problem trying to fly a plane. You need to figure our what's up and consult with an ame when you do.
 
PaulS said:
My wife has Menieres, not a fun issue. It eventually will result in total hearing loss. Vertigo is an issue with flying obviously. My wife controls it with a very low salt diet and avoiding caffeine.

The vertigo she gets would be a big problem trying to fly a plane. You need to figure our what's up and consult with an ame when you do.
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It's a pretty rough disease to have. I can't imagine experiencing this on a weekly/monthly basis.

I consume virtually no salt and I consume nothing with caffeine, no coffee, tea, etc. My dad has this issue and it occurs just as rarely for him as it does for me so perhaps it's some genetic issue. But I agree, vertigo, no matter how rare it occurs, is what is concerning me with respect to flying. I will search for an AME that is close to me.
 
It could be something else other than menieres too. Sodium is high in a lot of prepared foods and sauces. Don't forget these either. I hope you get this figured out.
 
My mom fought it for decades. She finally had one ear completely deadened to try to stop the rather disabling attacks. I can't see flying if your subject to such attacks (and I doubt the FAA would even consider certification).
 
I would not dive alone with Meniere's for sure, but then most people in recreational diving have one or more buddies, so disorientation would not be a guaranteed disaster. As a single pilot on an aircraft, my guess would be no way. I am not an AME though, so there may be ways around it, even if I cannot see them.
 
Sam7 said:
I get episodes of fairly intense vertigo. They last a few minutes, and usually occur 2-4 times in that specific day. Generally, I'm fine the next day. None of these episodes ever had any corresponding ear symptoms except for one of the last episodes I had which involved a loud ringing as well as my ear closing up alongside the vertigo.
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I'm replying just because your symptoms closely resemble some I've had.

In the past, I've had numerous incidents of vertigo over the years, diagnosed as BPPV (benign paroxysmal positional vertigo). I learned that they were triggered (in my case) by looking up at a particular angle, like when crawling under a vehicle on my back to look at something. They were successfully resolved by an Epley procedure (canalith repositioning), which I learned how to do at home. I actually haven't had one of these in a few years, probably because I learned to avoid the triggering activity.

But starting a few years back, I began having a different kind of incident, where I would have a sudden onset of tinnitus, followed almost immediately by some "pixelation" in my vision (I don't know how else to describe it) and vertigo. The entire incident would be over in 10-15 seconds, then everything returned to normal. This happened sitting, standing, and even once driving. (After the first time, I found I could just "power through," and it would quickly pass, with no lingering effects.) I discussed this with my PCP, ENT, and neurologist, and none could offer any explanation. Interestingly, those incidents seem to have ceased a year or so ago, replaced by now-constant tinnitus, but no vertigo or vision effects.

Getting old sucks.
 
I appreciate all the replies, thank you. I'm going to go ahead an assume flying is a no for now to save myself further disappointment whilst I find an ENT to conduct further tests :(

@Mikey B I originally entertained the thought of BPPV but if my memory is correct, none of these vertigo episodes occurred whilst I was orientating my head. I was just simply sitting or standing. I do have intermittent tinnitus which occurs in either ear maybe a few times a month. It usually subsides in 10-15 seconds so I never thought much of it. I'd like to think I have fairly good hearing as any time I have headphones on, volume is at the lowest level on whatever device I'm using, anything louder than that is just too loud.
 
How long ago was that doctor visit if it was longer then 3 years and he never diagnosed you then not something you need to report. What you could do is go get your medical certificate if it's been longer then 3 years since that ENT visit then go see an ENT and have this checked out. That way if it turns out you don't have it you can move over to basic medical you don't have to report the ENT visit. If you are diagnosed then you can decide what to do at that point what treatment can be done just forget the entire thing let your medical expire.

If you go before you get your class 3 then it opens a can of worms could take months to resolve even if your not diagnosed with it the FAA might ask for lot more testing. I wouldn't even mention the tinnitus unless it's so loud can't pass a hearing test. If I had to guess everyone over 50 probably has some little bit of it. Most just don't think about it and don't even notice it.
 
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kell490 said:
How long ago was that doctor visit if it was longer then 3 years and he never diagnosed you then not something you need to report. What you could do is go get your medical certificate if it's been longer then 3 years since that ENT visit then go see an ENT and have this checked out. That way if it turns out you don't have it you can move over to basic medical you don't have to report the ENT visit. If you are diagnosed then you can decide what to do at that point what treatment can be done just forget the entire thing let your medical expire.

If you go before you get your class 3 then it opens a can of worms could take months to resolve even if your not diagnosed with it the FAA might ask for lot more testing. I wouldn't even mention the tinnitus unless it's so loud can't pass a hearing test. If I had to guess everyone over 50 probably has some little bit of it. Most just don't think about it and don't even notice it.
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This was a couple of years ago. I'd have to look up the my appointment info to get the exact date. I explained to him what I explained above and he did not see the need to diagnose, cleared me for scuba diving, and told me I shouldn't worry about anything, just don't push myself under water past anything I'm not comfortable with.

The tinnitus doesn't affect me at all and is not a constant phenomenon, it just randomly pops up every month or so for a few seconds. My hearing is excellent and I go to great lengths to protect my ears. I equalize constantly when I'm below water, wear ear plugs when I swim, and wear plenty of noise-suppressing gear when I hunt and shoot.
 
IF it turns out the ENT was less then 3 years you will want to consult an AME do not fill out the FAA forms ask for a consult cost about $200 at least the one I have did. That way you find out what testing will be required let the AME tell you what the ENT test's need to be done. If you go first to the ENT and they run different test then the FAA wants now you have go back again. Also if you get the test done now and wait a few months before you go to the AME the FAA might want the test all over again. The AME might even have an ENT who understands what the FAA wants already lot of times from what I have read here is the FAA wants reports worded a certain way.

These are only options I guess if it was me I would want to know for sure I would never get vertigo while piloting a plane. Worst case you see the AME get the proper testing done and decide. If the test is negative the AME has everything they need preload the information that way the FAA likely won't have any questions.
 
kell490 said:
IF it turns out the ENT was less then 3 years you will want to consult an AME do not fill out the FAA forms ask for a consult cost about $200 at least the one I have did. That way you find out what testing will be required let the AME tell you what the ENT test's need to be done. If you go first to the ENT and they run different test then the FAA wants now you have go back again. Also if you get the test done now and wait a few months before you go to the AME the FAA might want the test all over again. The AME might even have an ENT who understands what the FAA wants already lot of times from what I have read here is the FAA wants reports worded a certain way.

These are only options I guess if it was me I would want to know for sure I would never get vertigo while piloting a plane. Worst case you see the AME get the proper testing done and decide. If the test is negative the AME has everything they need preload the information that way the FAA likely won't have any questions.
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Good call on seeing an AME first, should have done that but I'm seeing another ENT tomorrow for a second opinion. Fingers crossed all goes well. I suppose I can make an appointment with an AME also.

I agree with you, I would also like to know for sure that I'll never experiencing vertigo whilst piloting a plane. I can risk other activities but flying can very easily present a life/death situation should vertigo unexpectedly hit.
 
Update:

Had my ENT appointment today. The doctor turned out to be a really nice old timer who had some pilots in the family. I explained to him what had experienced in the past with vertigo (what I wrote in my original post above). He proceeded to check my ears and then I was administered a balance test, an ear pressure test, and a hearing test. I passed all with above average/normal results.

He saw no reason to diagnose me with anything and told me he'd be happy to sign off on anything I needed in the future regarding flying. So next stop is an appointment with an AME? Do I mention the ENT visits?
 
Sam7 said:
Update:

Had my ENT appointment today. The doctor turned out to be a really nice old timer who had some pilots in the family. I explained to him what had experienced in the past with vertigo (what I wrote in my original post above). He proceeded to check my ears and then I was administered a balance test, an ear pressure test, and a hearing test. I passed all with above average/normal results.

He saw no reason to diagnose me with anything and told me he'd be happy to sign off on anything I needed in the future regarding flying. So next stop is an appointment with an AME? Do I mention the ENT visits?
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When you complete the medxpress form, you will disclose all visits to medical professionals in the past three years. When you fill out the form, remember it is a government form, read the questions and instructions very carefully, and answer the questions asked and nothing more.
You still want to do a consult with the AME, not an exam for a medical certificate. You need to be clear about this when you make the appointment. If you are told the AME doesn't do consults, find a different AME. You may still complete the medxpress and print it out before your consult appointment. Do not give the doctor the confirmation number. He doesn't need it for a consult.

Here's what the FAA tells AMEs about vertigo, but it sounds like maybe that's not what you had and it was more like transient dizziness or something like that: https://www.faa.gov/about/office_or...ide/app_process/exam_tech/item46/amd/vertigo/
 
When you list the reason you went to see the ENT "Vertigo" it's going to set off a red flag.

From the link posted above " Numerous conditions may affect equilibrium, resulting in acute incapacitation or varying degrees of chronic recurring spatial disorientation. Prophylactic use of medications also may cause recurring spatial disorientation and affect pilot performance. In most instances, further neurological evaluation will be required to determine eligibility for medical certification.

You be looking at possibly an MRI when I see the words neurological evaluation I could only guess maybe the AME who posts here will see this thread chime in. Your looking at several months of waiting even if you get the testing done I don't expect an answer sooner then 6-8 months. I don't know if you know about light sport pilot doesn't require a medical cert once you start the process for a medical then you can't go light sport until you are approved which kind of defeats the purpose of going light sport. There isn't any logic to Government regulator that is another reason for the consult you can still decide to go light sport. Good luck.
 
Thank you for the replies. At this point, all that is left would be for me to get imaging done of my head, either a CT scan or MRI (preferably). I don't see how a neurologist can determine anything specific without imaging that two ENT's couldn't find. I'll start to look around for one.

If I understand you both correctly, I'm doing a consult to discuss all this with an AME and asses further courses of action but not put myself in a position to disqualify myself from flying since this wouldn't be an appointment for a medical certificate.
 
Sam7 said:
Thank you for the replies. At this point, all that is left would be for me to get imaging done of my head, either a CT scan or MRI (preferably). I don't see how a neurologist can determine anything specific without imaging that two ENT's couldn't find. I'll start to look around for one.

If I understand you both correctly, I'm doing a consult to discuss all this with an AME and asses further courses of action but not put myself in a position to disqualify myself from flying since this wouldn't be an appointment for a medical certificate.
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That is correct once you submit the form and give that number to the AME you have started your journey into a world of illogical government bureaucracy. Yes a consult will avoid going blindly down that path.

Make sure you find a good AME I google searched in my area found some websites of AME's who did it full time their websites said they specialized in hard to pass cases. I also looked on Facebook found a local aviation group in my area they also recommended the same ones I found on my google search. What you don't want is the AME who does it part time and says "I don't see a problem lets just wait see what the FAA says". Those will tend to be the ones who refuse to do consults also require you to fill out the MedExpress form online first. I would print out the form Fill in the medical questions part by hand writing on the form. You can print it out link below. This might not be the exact online version it's close enough to give the AME the information he needs.

https://www.aviationmedicine.com/wp...PPLICATION-FOR-AIRMAN-MEDICAL-CERTIFICATE.pdf
 
You may have a food allergy. Been there. For me it’s whiskey, which has been a fav, and the symptoms developed gradually. When out of the country and no American whiskey was available, I discovered a big improvement in equilibrium. I’m not talking about hangover quantities and I didn’t avoid liquor, just no whiskey. It’s been a happy discovery.

My doctor tells me the foods we crave are often the triggers for allergic symptoms, but may not qualify as allergies.

In the short term try Allegra. It worked better than anything else I tried. Claritin was a close second.
 
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I recently went to my doctor for what felt like an ear ache I thought there was wax in my ear, or I had an inner ear infection. He found nothing diagnosed possible TMJ. About 10 days later I started having pain on one tooth just drinking water dentist said I need a root canal. Root canal wasn't much fun finely finished up 2 days ago. Guess what no more inner ear issue Dentist said tooth can cause problems with inner ear all connected.
 
@kell490 Thank you for all the advice you've give me, you have been most helpful. A quick search of AME's around me and I get what you're saying with respect to "part-timers" and those who require you to have the MedExpress with confirmation # done before you walk in. I shall diligently keep looking and make some phone calls.

Things are all jumbled and interconnected once you're in the head region. I'm not surprised teeth problems can cause inner ear issues.

@Stewartb I distinctly remember most of my vertigo episodes, partly because I hate anything to do with the sensation of spinning and partly because they're so rare (thankfully). I'm most certain I wasn't ingesting anything at or around the time they occurred but I will keep this in mind, perhaps I'm missing something.
 
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Hate to keep bringing this up but I've had no luck finding an AME that will do just a consultation (despite my offering to pay them). I've contacted at least a dozen of them around the city I live in (Los Angeles) and they all say that they don't do consults, that I need to take an appointment, and that I need to have my MedXpress filled out with confirmation number before I walk in :mad:
 
Sam7 said:
Hate to keep bringing this up but I've had no luck finding an AME that will do just a consultation (despite my offering to pay them). I've contacted at least a dozen of them around the city I live in (Los Angeles) and they all say that they don't do consults, that I need to take an appointment, and that I need to have my MedXpress filled out with confirmation number before I walk in :mad:
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One more thing for the California list. Jeeze that place just sucks
 
Seriously! If anyone knows an AME who is willing to do a consultation, let me know! I'll even do a Zoom call or normal call or whatever and I will most certainly pay them for their time.
 

I wonder what the status of the experimental treatment is that Alan Shepard had. He had Menieres that was cured and allowed him to go to the moon.
 
geneseib said:
I wonder what the status of the experimental treatment is that Alan Shepard had. He had Meniere's that was cured and allowed him to go to the moon.
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He had an endolymphatic sac shunt surgery to drain the ear of fluid build-up. With respect to how he's doing now, no clue but a book I read detailing the space flights indicated that he was completely cured.

I don't know whether or not I have Meniere's, it was just a self-diagnosis. One ENT said maybe, the other ENT said no. From what I understand, Meniere's causes chronic symptoms whereas mine don't even happen on an annual basis so it could very well be something else entirely.
 
Finally got some answers from a few AMEs. It was suggested, however, I accompany my ENT test documents that I will be sending to the FAA with a cover letter explaining the reason for the visits in the first place. Any specific way I should write this letter or just a simple business format correspondence should suffice?
 
Sam IF the diagnosis of menieres hasn't been excluded, the FAA std. is "no episodes in the past 365 days"......
 
bbchien said:
Sam IF the diagnosis of menieres hasn't been excluded, the FAA std. is "no episodes in the past 365 days"......
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Hi Dr. Chien, thanks for chiming in!

I saw two ENT's and neither saw fit to diagnose me with anything after describing to them the situation. The last episode I had was nearly 6 years ago.

I'm assuming I would indicate this in my cover letter along with the reason as to why I saw the ENT's in the first place?
 
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