Dizziness: When to See an ENT Specialist

Dizziness concerns?

Hello Doctor, last May while taking a shower, I suddenly experienced a bout of dizziness (a spinning sensation), and due to the severity of the dizziness, I also had nausea and vomiting.
After that, I felt dizzy every day for about 1-2 weeks, but it eventually resolved on its own.
I previously did not have issues with dizziness, but since that incident, I have started to feel dizzy after getting vaccinated and also when I am fasting.
These symptoms were not present before.
After being diagnosed in August, I noticed that I experience dizziness close to my menstrual period or after it ends.
This dizziness is not the spinning type; rather, it feels like my body is unstable, and it becomes more pronounced when I walk.
I often feel the need to sit down or squat to rest after walking a short distance.
During these dizzy spells, I also tend to feel sleepy or experience a sensation of pressure in my head.
The dizziness varies; sometimes it improves on its own within 1-2 weeks, while other times it persists for an entire month, usually more noticeable in the afternoon and evening, and it worsens during my menstrual period, which is also accompanied by headaches and discomfort.
In February of this year, I visited a neurologist for an examination, and the EEG showed no abnormalities.
The doctor prescribed a medication called Nootropil, which I have been taking for 2-3 weeks without noticeable improvement.
In January of this year, I went to the emergency room due to dizziness and chest discomfort, and blood tests showed no abnormalities, including no anemia.
In addition to dizziness, I occasionally experience tinnitus.
I would like to ask the doctor if this condition is related to issues with blood circulation causing dizziness, or if I should consult an ENT specialist for further evaluation.
Thank you.

Niming, 20~29 year old female. Ask Date: 2023/06/07

Dr. Zheng Jueyi reply Otolaryngology

Hello, dizziness caused by general inner ear issues often presents as a spinning sensation; therefore, the symptoms may not resemble those of inner ear diseases.
If medication is not effective, it is recommended to return to a neurologist for medication adjustment.
Additionally, it is advised to walk or exercise regularly to train balance.

Reply Date: 2023/06/07

More Info

Dizziness can be a perplexing symptom, often leading to concerns about underlying health issues. In your case, the episodes of dizziness, particularly the severe vertigo you experienced while showering, followed by persistent lightheadedness, suggest that a thorough evaluation is warranted. Given the complexity of your symptoms, it is essential to consider various potential causes, including vestibular disorders, neurological issues, and even hormonal fluctuations related to your menstrual cycle.

Firstly, the sudden onset of severe dizziness accompanied by nausea and vomiting could indicate a vestibular event, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis. These conditions can cause episodes of vertigo that may resolve spontaneously but can also lead to lingering balance issues. The fact that you have experienced dizziness more frequently since that initial episode, especially in relation to your menstrual cycle, raises the possibility of hormonal influences on your vestibular system.

Your mention of feeling unsteady while walking and the need to rest frequently suggests that your balance may be affected. This could be due to a vestibular dysfunction, which is often evaluated by an Ear, Nose, and Throat (ENT) specialist. ENT specialists are trained to assess and manage conditions related to the inner ear, which plays a crucial role in balance. They can perform specific tests, such as the Dix-Hallpike maneuver, to diagnose BPPV or other vestibular disorders.

Additionally, your history of headaches and the timing of your dizziness in relation to your menstrual cycle could indicate a connection to migraines. Some individuals experience vestibular migraines, where dizziness is a prominent symptom, often triggered by hormonal changes. If this is the case, a neurologist may also be involved in your care to address the migraine component.

The fact that you have undergone neurological evaluations, including an EEG, which returned normal, is reassuring. However, it is essential to continue investigating the dizziness, especially since it has become a recurring issue. The absence of anemia and other blood abnormalities is also a positive sign, but it does not rule out other causes of dizziness.

In summary, given your symptoms, it would be prudent to consult with an ENT specialist. They can conduct a comprehensive evaluation of your vestibular function and determine if there are any underlying ear-related issues contributing to your dizziness. If necessary, they may collaborate with a neurologist to address any potential migraine-related dizziness or other neurological concerns.

In the meantime, keeping a diary of your dizziness episodes, noting their frequency, duration, and any associated symptoms, can be helpful for your healthcare providers in making an accurate diagnosis. This information can guide them in determining the most appropriate treatment plan for your condition.

Ultimately, dizziness can stem from various sources, and a multidisciplinary approach involving both ENT and neurology may provide the best outcomes. Don't hesitate to seek further evaluation, as understanding the root cause of your symptoms is crucial for effective management and improving your quality of life.

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