Chronic Dizziness: When to See a Specialist - Neurology

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Chronic dizziness


Hello, I have been experiencing dizziness for 4 to 5 years, almost every day.
Sometimes it feels like I'm floating as if in a dream, and at other times, it feels like being on a boat, with moments of calm and moments of swaying with the wind.
Occasionally, it feels like I'm hitting a reef, and during these times, I usually experience nausea, but I have never actually vomited or fainted.
In addition to dizziness, I occasionally have palpitations and chest tightness.
Sudden movements, like turning my head or standing up after squatting, make the dizziness worse, and sometimes my vision goes completely black.
However, after resting for a while, the symptoms tend to ease.
I would like to ask the doctor which specialty I should prioritize for these symptoms.
Thank you for your response!

D., 20~29 year old female. Ask Date: 2016/05/14

Dr. Gao Chunde reply Neurology


You can first consult a family physician to determine if there is anemia or low blood pressure.
If those conditions are ruled out, then it is important to consider potential issues with inner ear function.
If necessary, the physician may refer you to an otolaryngologist or a neurologist for further evaluation and treatment.

Reply Date: 2016/05/14

More Info


Chronic dizziness can be a perplexing and distressing symptom, especially when it has persisted for several years, as in your case. The sensations you describe—feeling as if you are floating, swaying, or experiencing a rocking motion—are often associated with vestibular disorders, which involve the inner ear and its connections to the brain. The accompanying symptoms of nausea, palpitations, and chest tightness further complicate the picture and may suggest a multifactorial issue.

Given the duration and nature of your symptoms, it is advisable to consult a specialist. The first step would typically be to see an otolaryngologist (ENT specialist), particularly one who specializes in vestibular disorders. They can perform a thorough evaluation of your inner ear function, which is crucial since the vestibular system plays a key role in balance and spatial orientation. Tests such as videonystagmography (VNG) or electronystagmography (ENG) may be conducted to assess your eye movements and balance function.

If the ENT specialist rules out vestibular causes, or if they suspect that your symptoms may be related to neurological issues, they may refer you to a neurologist. Neurological conditions can sometimes manifest as dizziness, and a neurologist can conduct further evaluations, including imaging studies like an MRI, to rule out any central nervous system disorders.

Additionally, your symptoms of palpitations and chest tightness warrant attention. It may be beneficial to see a cardiologist as well. They can assess your heart health through an electrocardiogram (ECG) or echocardiogram to ensure that there are no underlying cardiac issues contributing to your symptoms.

In summary, the best course of action would be to start with an ENT specialist to evaluate for vestibular disorders. Depending on their findings, you may then be referred to a neurologist or cardiologist for further assessment. It is important to approach this systematically, as dizziness can stem from various sources, including inner ear problems, neurological conditions, or cardiovascular issues.


Additional Considerations
1. Lifestyle Factors: Consider keeping a diary of your symptoms, noting when they occur, their duration, and any potential triggers (such as certain movements or activities). This information can be invaluable for your healthcare providers.

2. Medication Review: If you are taking any medications, review them with your doctor, as some can cause dizziness as a side effect.

3. Hydration and Nutrition: Ensure you are well-hydrated and maintain a balanced diet, as dehydration and low blood sugar can exacerbate dizziness.

4. Physical Therapy: If vestibular dysfunction is diagnosed, vestibular rehabilitation therapy (VRT) may be recommended. This is a specialized form of physical therapy designed to help improve balance and reduce dizziness.

5. Mental Health: Chronic dizziness can also lead to anxiety and stress, which can further exacerbate symptoms. If you find that your mental health is affected, consider discussing this with your healthcare provider.

In conclusion, while chronic dizziness can be challenging to diagnose and treat, a systematic approach involving the right specialists can lead to effective management and improvement of your symptoms. Don't hesitate to seek help, as addressing these symptoms can significantly enhance your quality of life.

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