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Pernicious Anaemia Society
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I've had a problem with my left ear my entire life and have had a grommet fitted for over a decade. However, this year problems have amounted and I am interested to know if you feel any of this is related to B12.

I started the year with Flu at Christmas (proper can't get out of bed type), followed by infected sinuses and toothache. Had to have the tooth removed. Then developed post viral fatigue, which lasted a few weeks.

A month or two later went to doc thinking I might have thyroid issue, ridged nails, pins and needles in my hands every morning, still very fatigued, frequently feeling cold. Doc did blood test which showed the B12 deficiency, had six loading doses and am now on three monthly injections.

Two months ago got another infected tooth and ear infection, had three lots of different antibiotics and root canal filling to sort that. But meanwhile have developed dizziness, ringing in the ears and room spinning moments that are quite worrying. Went back to doctor who has re referred me to ENT consultant (in addition grommet has displaced). He has suggested Vertigo.

Do I have two separate issues going on or could the vertigo (possibly Ménière's disease) be related to the B12 deficiency?

9 Replies


Vertigo can be a symptom of B12 deficiency. See lists of symptoms below.

pernicious-anaemia-society.... Checklist PDF on right of page.



It's important to exclude other possible causes of vertigo though.

I have mild vertigo...used to be really good with heights but not anymore and I can't stand close to cliff edges etc because I feel like I'm going to fall over the edge.

"had six loading doses and am now on three monthly injections."

People with B12 deficiency with neurological symptoms should be on loading jabs every other day for as long as symptoms continue to improve (could mean loading jabs for weeks even months) then injections every 2 months. I believe vertigo counts as a neurological symptom.

Do you have other neuro symptoms eg tingling, pins and needles, tinnitus, memory issues, balance problems plus other possible neuro symptoms.

If yes, has GP explained why you are on standard treatment regime for B12 deficiency without neuro symptoms rather than the treatment regime for those with b12 deficiency with neuro symptoms?

Details of UK B12 treatment can be found in

1) BNF British National Formulary Chapter 9 Section 1.2

All UK Gps will have access to BNF. It's possible to get own copy.



2) BSH Cobalamin and Folate Guidelines, about a quarter through guidelines.


Untreated or undertreated B12 deficiency can put a person at risk of permanent neuro damage including spinal problems. Some forum members who have struggled to get correct level of treatment have showed their GPs a copy of PAS article on SACD, sub acute combined degeneration of the spinal cord as an example of the consequences of undertreated B12 deficiency.

PAS article SACD only available to PAS members.

pernicious-anaemia-society.... See Symptoms Section

PAS news item about neurological consequences of PA


I am not medically trained.


Thank you for swift detailed reply. I will look into all of your suggestions/sources.


If you're unhappy with treatment, these links may be useful.

Link about writing to GPs about B12 deficiency


Point 1 is about undertreatment of neurological symptoms

CAB Citizens Advice Bureau NHS complaints


HDA patient care trust


UK charity that offers free second opinions on medical diagnoses and medical treatment.

"Doc did blood test which showed the B12 deficiency, had six loading doses and am now on three monthly injections."

Did GP order an Intrinsic Factor Antibody test? This can help to diagnose PA but test is not always reliable and it is still possible to have PA even if IFA tets result is negative/normal range (called Antibody Negative PA).

Flowchart below outlines when PA should be diagnosed in UK.


Makes it clear that in UK, IFA test should be carried out on people who are symptomatic for B12 deficiency.

Have you had an Intrinsic Factor Antibody test?

I hope GP is trying to find out why you are B12 deficient. Do you have a diet that has B12 rich foods eg meat, fish, shellfish, dairy, eggs?

If yes, dietary cause of b12 deficiency is less likely and it becomes more likely that there is an absorption problem.

Have you been tested for Coeliac disease?


NICE guidelines Coeliac disease


"went to doc thinking I might have thyroid issue"

Did you have any thyroid tests?


Sometimes UK doctors only test TSH which will not give a full picture of thyroid function. If you have any thyroid results, it may be worth posting them on Thyroid UK forum on HU.


Eaoz, there are different types of balance problems and B12 deficiency does affect several systems so can lead to different types - and meniere's is a possible misdiagnosis of B12 deficiency.


Damn! I'm one of those patients who use the terms interchangeably.

Many years ago I had a short period when I suffered random attacks of vertigo (proper spinning stuff). After my PA diagnosis I always assumed that those attacks were an early sign. Now it looks like they weren't.


whilst the terms may have specific clinical meaning when used by a clinician in general parlance they may not necessarily be used by ordinary people in the same way.

Personally I can relate to room spinning as a description of the way I experienced balance problems when my B12 deficiency was very bad.

Vertigo is often used as a description for dizziness problems in relation to heights - something that is very common in people who are B12 deficient - coming down stairs being really difficult as opposed to going up stairs and feeling very exposed when looking down from a height.

There are some very specific tests for neurological problems caused by other conditions but they aren't necessarily applied accurately by GPs in diagnosing problems with the result that the wrong labels are applied.


Additionally anxiety is a possible consequence of B12 deficiency, and one of the symptoms of dizziness can be room spinning so I'd rather not assume that just because someone has used a particular term that they mean what a medical text book would mean by it - without formally checking that first.


Auntieglitterball, suggest that you keep a diary of symptoms you have that could be associated with B12, what happens to them when you have your maintenance shot and when they start returning after your maintenance shot -

many people find that 3 months really is too long in between maintenance shots - in fact I've come across very few who do find it sufficient but there obviously are some out there.

Hope the materials provided by Sleepybunny are useful


Thank you all for joining in the comments here. I feel well supported. Plenty to think about and questions to ask.

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