Dizziness and Imbalance: When to Seek Further Evaluation

Q: Dizziness and Imbalance: When to Seek Further Evaluation

Hello： If your symptoms raise suspicion of a stroke in the ear, you can discuss with your physician the possibility of undergoing relevant examinations such as brain imaging. <br>It is recommended that you consult with a neurologist or an otolaryngologist for discussion and treat

Dizziness and a sense of imbalance?

Hello Doctor,
About two weeks ago, I visited the hospital due to severe dizziness accompanied by a feeling of ear fullness, hearing loss, and tinnitus.
The doctor assessed it as either inner ear edema or a vestibular stroke.
A week ago, I returned to the hospital for a follow-up, and the results of the hearing test (PTA) showed significant improvement compared to the previous week.
However, I am unsure if this improvement is genuine or if the initial results were affected by my fatigue during the first test, creating a false impression of recovery.

As for the dizziness, it has noticeably improved since two weeks ago, but I still feel a persistent lightheadedness.
This lightheaded feeling refers to a more pronounced visual disturbance than normal; at times, I feel like the floor is slanted, and I occasionally experience slight instability while walking, though I do not fall.
Most of the time, my walking speed and manner are relatively normal.
I rarely experience dizziness except when lying down, and even then, I only feel slight dizziness (a spinning sensation) when I lie on my left side.
The tinnitus issue persists but has also slightly improved.

Earlier, I came across a video online about a celebrity with an acoustic neuroma, and their dizziness fluctuated, which made me worry that I might also have an acoustic neuroma or a more serious brain tumor or lesion.
This mild imbalance and dizziness have been ongoing for about two weeks.
Should I seek further brain imaging at the hospital?
Note: I have a tendency towards health anxiety and am currently receiving psychiatric treatment.
Thank you, Doctor, for taking the time to read and respond!

Xiao Ming, 20~29 year old female. Ask Date: 2021/03/06

Dr. Jiang Junyi reply Neurology

Hello: If your symptoms raise suspicion of a stroke in the ear, you can discuss with your physician the possibility of undergoing relevant examinations such as brain imaging.
It is recommended that you consult with a neurologist or an otolaryngologist for discussion and treatment.
Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Medical University, cares about you.

Reply Date: 2021/03/06

More Info

Dizziness and imbalance can be concerning symptoms, especially when they persist over time. In your case, the combination of dizziness, ear fullness, hearing loss, and tinnitus suggests a potential issue with the inner ear, such as vestibular dysfunction or possibly a condition like Meniere's disease or vestibular neuritis. Your recent improvement in hearing and the reduction in dizziness are positive signs, but the lingering feelings of imbalance and dizziness warrant further evaluation.

The symptoms you describe, particularly the sensation of the floor tilting and the feeling of being unsteady, can be indicative of vestibular disorders. The inner ear plays a crucial role in maintaining balance, and any dysfunction can lead to the symptoms you are experiencing. The fact that your dizziness improves when lying down but worsens when turning to one side could suggest a positional component, such as Benign Paroxysmal Positional Vertigo (BPPV), although this would typically cause more intense episodes of vertigo rather than a constant feeling of imbalance.

Regarding your concerns about a vestibular schwannoma (acoustic neuroma) or other serious intracranial pathology, it is understandable to feel anxious, especially with the information you have encountered online. While vestibular schwannomas can cause similar symptoms, they are relatively rare, and the gradual onset of your symptoms, along with the improvement you have noted, may suggest a less serious underlying condition. However, given your persistent symptoms and the fact that you have a history of anxiety, it is prudent to seek further evaluation.

I recommend scheduling an appointment with an otolaryngologist (ENT specialist) who can perform a thorough examination and may recommend additional tests, such as an MRI of the brain, to rule out any structural abnormalities. An MRI is particularly useful in assessing for tumors or other lesions that could be affecting your auditory and vestibular systems. Additionally, vestibular function tests may be conducted to evaluate how well your inner ear is functioning.

It's also important to address your anxiety regarding health concerns. Anxiety can exacerbate physical symptoms, including dizziness and imbalance. Continuing your treatment with a mental health professional is essential, and they can help you manage your anxiety while you navigate these health concerns.

In summary, while your symptoms have improved, the ongoing feelings of imbalance and dizziness, especially with the history of ear fullness and hearing loss, warrant further investigation. An ENT specialist can provide a comprehensive evaluation and determine if imaging or additional tests are necessary. Remember to communicate openly with your healthcare providers about your symptoms and any anxiety you may have, as they can offer support and guidance tailored to your needs.

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