Dizziness: When to Seek ENT Care for Head Movements

Dizziness when bending down or turning the head?

Hello, doctor.
For the past two to three weeks, I have been experiencing sudden dizziness when I look down or turn my head.
When I bend over to wash my hair or shower at a low angle, I immediately feel dizzy and almost can't stand.
Occasionally, while walking and looking around, I also experience dizziness, which startles me and keeps me on high alert.
The family doctor at my local clinic prescribed me anti-vertigo medication, which helps a bit but is not consistently effective.
Due to the pandemic, I have been avoiding going to a large hospital.
Should I still seek treatment at a larger hospital? In my thirties and forties, I had two episodes of dizziness due to benign paroxysmal positional vertigo (BPPV) and went to the hospital and clinic for treatment, where the doctor performed the Epley maneuver to relieve my symptoms.
I wonder if this time it could be a similar situation.
A few months ago, I experienced severe vertigo and vomiting, but after resting for an hour or two, I recovered.
I am unsure if these two episodes are related.
Thank you, doctor.

Ong Picton, 60~69 year old female. Ask Date: 2021/06/28

Dr. Zheng Jueyi reply Otolaryngology

Hello, regarding the symptoms of dizziness triggered by changes in posture, along with a history of benign paroxysmal positional vertigo (BPPV), the most common cause remains otolith displacement.
It is advisable to consider visiting a clinic or hospital for an otolith repositioning procedure.
However, if the symptoms persist or worsen for more than two to three weeks without improvement, other factors should be considered.
If the dizziness continues without improvement, it is recommended to seek further evaluation at a hospital.
Wishing you safety and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/06/28

More Info

Dizziness, particularly when associated with head movements, can be a concerning symptom that warrants careful evaluation. Based on your description, it seems that you are experiencing episodes of dizziness when bending down or turning your head, which can be quite alarming and may affect your daily activities. Given your history of benign paroxysmal positional vertigo (BPPV) due to ear stone displacement, it is possible that you might be experiencing a recurrence of this condition.

BPPV is a common cause of dizziness that occurs when tiny calcium carbonate crystals in the inner ear become dislodged and move into one of the semicircular canals. This can lead to brief episodes of vertigo, especially when changing the position of your head. The symptoms you describe—dizziness when bending down or turning your head—are characteristic of BPPV. The fact that you have had similar episodes in the past and received effective treatment through repositioning maneuvers further supports this possibility.

While the medication prescribed by your family doctor may provide some relief, it is often not a long-term solution for positional vertigo. The most effective treatment for BPPV is a series of specific head and body movements known as the Epley maneuver or other vestibular rehabilitation techniques. These maneuvers help to reposition the dislodged crystals back to their proper location in the inner ear, thereby alleviating the dizziness.

Given your recent experiences of dizziness, especially the episode of severe vertigo accompanied by nausea and vomiting, it is advisable to seek further evaluation from an ear, nose, and throat (ENT) specialist or a neurologist. They can perform a thorough examination, including a detailed history and physical examination, and may conduct specific tests to confirm the diagnosis. These tests may include the Dix-Hallpike maneuver, which is specifically designed to diagnose BPPV.

Additionally, it is important to rule out other potential causes of dizziness, such as vestibular neuritis, Meniere's disease, or even central causes like migraines or neurological disorders. Your symptoms, particularly the episodes of severe dizziness and nausea, should not be overlooked, especially if they are recurrent or worsening.

In summary, while your initial treatment with medication may provide temporary relief, it is crucial to address the underlying cause of your dizziness. Given your history of BPPV and the nature of your symptoms, seeking care from an ENT specialist or a neurologist is a prudent step. They can provide a comprehensive evaluation and appropriate treatment options, which may include vestibular rehabilitation therapy or further diagnostic testing if necessary. Remember, it is always better to err on the side of caution when it comes to symptoms like dizziness, especially if they impact your quality of life.

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