What is the cause of persistent vertigo, blurred vision, tinnitus, and recent excessive weight gain in a 49-year-old female after ear wax removal, and could it be related to an underlying internal condition, considering previous consideration of Qsymia (phentermine and topiramate) for weight loss?

From the Guidelines

I strongly recommend that you schedule an appointment with your healthcare provider to address both your vertigo symptoms and weight concerns as soon as possible, given the potential for underlying conditions that could impact your morbidity, mortality, and quality of life. The persistent vertigo with blurred vision after ear wax removal suggests there may be an underlying issue beyond impacted cerumen, possibly related to your inner ear, as noted in the clinical practice guideline for Meniere's disease 1. Conditions like benign paroxysmal positional vertigo (BPPV), Meniere's disease, or vestibular neuritis could be responsible. Your provider may refer you to an ENT specialist or neurologist for further evaluation, which might include:

• Balance testing
• Hearing tests
• Imaging studies, as guided by the ACR Appropriateness Criteria for tinnitus and related symptoms 1 Regarding your weight concerns, the combination of rapid weight gain and difficulty losing weight could indicate hormonal issues such as thyroid dysfunction, insulin resistance, or medication side effects. Your provider should order comprehensive bloodwork including:
• Thyroid function tests
• Metabolic panel
• Possibly hormonal studies, to rule out underlying causes as suggested by the clinical practice guideline for tinnitus 1 While Qsymia (phentermine-topiramate) might help with weight management, it's essential to identify any underlying medical causes first, as emphasized in the guideline for tinnitus 1. In the meantime, track your vertigo episodes (timing, duration, triggers) and maintain a food and weight journal to provide your doctor with detailed information that will help determine the appropriate next steps for both conditions. It is crucial to approach your symptoms with a thorough evaluation to ensure that any potential underlying conditions are identified and managed appropriately to prioritize your morbidity, mortality, and quality of life.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Vertigo and Vestibular Dysfunction

• The patient's complaint of vertigo and blurred vision may be related to vestibular dysfunction, which can be caused by various factors, including benign paroxysmal positional vertigo (BPPV), Meniere disease, or vestibular neuritis 2.
• The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies of vertigo, with peripheral etiologies being usually benign and central etiologies often requiring urgent treatment 2.
• There is also a potential link between Hashimoto thyroiditis (HT) and vestibular dysfunction, with studies suggesting that patients with Meniere disease or BPPV may be more likely to develop HT 3.

Weight Gain and Potential Underlying Conditions

• The patient's excessive weight gain in a short period and slow weight loss may be related to an underlying condition, such as hypothyroidism, which is often associated with Hashimoto thyroiditis 3.
• Further evaluation, including laboratory testing and physical examination, may be necessary to determine the cause of the patient's weight gain and vestibular symptoms.

Next Steps

• The patient may benefit from a thorough physical examination, including orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver 2.
• Laboratory testing, such as thyroid function tests, may also be necessary to evaluate for potential underlying conditions, including Hashimoto thyroiditis 3.
• Referral to a specialist, such as an otolaryngologist or an endocrinologist, may be necessary to further evaluate and manage the patient's symptoms.