Persistent Dizziness: Possible Causes and Next Steps

Feeling dizzy all day without being able to identify the cause?

Hello Doctor, my detailed experience is as follows: I usually have no illnesses, mostly just nasal allergies with clear nasal discharge.
On April 18th, I went to bed at 12:30 AM, which is later than usual.
In the morning of April 18th, I experienced a brief episode of dizziness and some discomfort in my abdomen, but it returned to normal after a few seconds.
On the morning of April 20th, I woke up feeling dizzy and slightly feverish.
That evening, I visited a family physician who suggested it might be heat exhaustion since it was indeed very hot that day, but my temperature was normal.
The doctor prescribed medication.
From April 21st to April 23rd, I continued to feel dizzy but had no other symptoms.
On the evening of April 24th, the dizziness turned into slight pain, so I visited the family physician again.
The doctor said everything looked normal externally and my blood pressure was fine, suspecting it might be psychological.
When I got home, I noticed mild pain in my ear.
After researching online, I suspected it might be otitis media, so I went to see an ENT specialist.
The doctor diagnosed me with mild otitis externa and suspected a virus above my nose was pressing on a nerve.
That night, I had insomnia and struggled to fall asleep.
On April 25th, there was no improvement; I felt some bloating in my upper abdomen and had the urge to defecate.
On April 26th, I returned to the ENT specialist, who reiterated that a virus above my nose was pressing on a nerve.
I asked the doctor how to classify a cold without fever or yellow nasal discharge, and he said that one can still have a cold without those symptoms.
I was advised to continue taking medication and wait for antibodies to develop.
After mentioning my abdominal symptoms and dizziness (with slight pain), I was prescribed a small dose of acetaminophen for the headache.
Currently, I still feel dizzy (and in pain), but I can move normally without feeling like the room is spinning.
There is slight discomfort in my upper abdomen, and the headache is causing some insomnia.
I would like to ask the doctor if I should go to a major hospital to see a neurologist for further testing, including imaging of the brain and blood tests, or if there are other recommendations.
Additionally, I experienced three episodes of dizziness in February and March of this year, all while lying in bed using my phone, which took about ten minutes to resolve.
I am unsure if this was caused by focusing on my phone.
Recently, when my nasal congestion is severe, my taste and smell have diminished, and I can only taste sour, sweet, bitter, and spicy, but cannot detect deeper flavors.
I would appreciate your clarification on these issues.
Thank you.

Touhun de Nimingzhe, 30~39 year old female. Ask Date: 2023/04/27

Dr. Ji Zhaoyun reply Otolaryngology

Hello, your symptoms are somewhat atypical and may be caused by different conditions, such as concurrent sinusitis and vestibular neuritis, among others.
It is advisable to seek medical evaluation if the symptoms persist.

Reply Date: 2023/04/27

More Info

Persistent dizziness can be a perplexing symptom, and understanding its potential causes is crucial for effective management. Based on your detailed history, several factors may contribute to your dizziness, and it is essential to explore them systematically.

Possible Causes of Dizziness
1. Vestibular Disorders: Conditions affecting the inner ear, such as vestibular neuritis or benign paroxysmal positional vertigo (BPPV), can lead to episodes of dizziness. Your mention of slight ear pain and the diagnosis of mild external otitis could suggest an underlying vestibular issue, especially if the dizziness is exacerbated by head movements.

2. Neurological Factors: Given your history of dizziness episodes, particularly when using your phone in bed, it is worth considering whether visual strain or changes in head position may be triggering your symptoms. Additionally, the possibility of a neurological condition, such as migraine-associated vertigo or even more serious conditions like multiple sclerosis, should not be overlooked, especially if dizziness persists or worsens.

3. Viral Infections: Your symptoms of nasal congestion and the doctor's suggestion of a viral infection could indicate that a viral upper respiratory infection is contributing to your dizziness. Viral infections can lead to inflammation in the inner ear, affecting balance.

4. Dehydration or Heat-Related Illness: The initial diagnosis of potential heat exhaustion suggests that dehydration or heat-related illness could have played a role in your dizziness, particularly if you were exposed to hot weather without adequate hydration.

5. Psychological Factors: Anxiety and stress can manifest as physical symptoms, including dizziness. The fact that your dizziness has been accompanied by sleep disturbances and discomfort may indicate a psychological component.

6. Gastrointestinal Issues: Your report of abdominal discomfort and changes in bowel habits could also be related. Gastrointestinal disturbances can sometimes lead to dizziness due to dehydration or electrolyte imbalances.

Next Steps
Given the complexity of your symptoms, it would be prudent to take the following steps:
1. Consult a Neurologist: Since your dizziness has persisted and you have experienced multiple episodes, a referral to a neurologist is advisable. They can perform a thorough evaluation, including a neurological examination and potentially imaging studies (like an MRI) to rule out any central causes of dizziness.

2. Vestibular Testing: If vestibular disorders are suspected, specialized tests such as a VNG (videonystagmography) or ENG (electronystagmography) can help assess inner ear function.

3. Blood Tests: A complete blood count (CBC), metabolic panel, and thyroid function tests can help identify any underlying systemic issues, such as anemia or thyroid dysfunction, that could contribute to your symptoms.

4. Monitor Symptoms: Keep a detailed diary of your dizziness episodes, noting their frequency, duration, and any associated symptoms. This information can be invaluable for your healthcare provider in diagnosing the underlying cause.

5. Manage Allergies: Since you mentioned having nasal allergies, consider discussing with your doctor the possibility of allergy testing or treatment options that may alleviate your symptoms and potentially reduce associated dizziness.

6. Hydration and Nutrition: Ensure you are adequately hydrated and maintain a balanced diet, as dehydration and nutritional deficiencies can exacerbate dizziness.

Conclusion
Persistent dizziness can arise from a multitude of causes, and your symptoms warrant a comprehensive evaluation. While some factors may be benign, others could indicate more serious conditions that require prompt attention. Consulting with a neurologist and possibly undergoing vestibular testing will help clarify the diagnosis and guide appropriate treatment. In the meantime, managing your allergies and ensuring proper hydration may provide some relief. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the best possible care.

Similar Q&A

Understanding Persistent Dizziness: Causes and Management Options

Hello Doctor: I have been experiencing dizziness for almost three years, and I have been taking medication to manage it. The dizziness initially presented as a gradual onset of vertigo, after which I sought medical attention and started medication. My condition has been fluctuati...

Dr. Ye Boshou reply Neurology
1. There are many causes of dizziness. In a 23-year-old individual with normal EEG results, tinnitus may occur. Is there any hearing impairment? If so, it could be related to inner ear balance issues. 2. Additionally, autonomic nervous system dysfunction and anxiety can also occa...

Persistent Dizziness for Two Weeks: Possible Causes and Next Steps

On August 25, I suddenly started experiencing dizziness, headaches, pain around my right eye, vomiting, and difficulty focusing on the computer screen, especially with text, which made me feel nauseous. My vision has been somewhat blurry. I visited an ophthalmologist, who found m...

Dr. Peng Shiwei reply Neurology
Hello, whether you need to undergo a CT scan should be discussed with your attending physician. Thank you for your question.

Understanding Persistent Dizziness: Possible Causes and Solutions

Hello: I have been experiencing persistent dizziness for over a year. I have undergone various tests, including CT scans and brain ultrasounds, all of which returned normal results. The dizziness, which starts in the afternoon and radiates from the back of my neck to the back of ...

Dr. Lai Lunxiang reply Neurology
Hello, I believe you may be experiencing 1. neurosis and 2. polycythemia. Therefore, please visit the outpatient clinic for a consultation. Thank you!

Understanding Persistent Dizziness: Possible Causes and Next Steps

Hello Doctor, I have been experiencing dizziness for over a month. I have consulted with a neurologist, an otolaryngologist, and a cardiologist, and all tests have come back normal. However, my symptoms have not improved with medication. The symptoms seem to be best described as ...

Dr. Jiang Junyi reply Neurology
Hello Mr. Wang, You mentioned that "the symptoms improve slightly after getting up in the morning... and the body feels like it's swaying." This may indicate proprioceptive abnormalities caused by cervical spine issues. Often, this is related to muscle fascia tigh...