Persistent Dizziness: Possible Causes and Treatment Options

Persistent dizziness and vertigo?

Hello Doctor, I discovered over a year ago that I have poor hearing in my left ear, along with unilateral tinnitus, a feeling of fullness in the ear, and headaches.
I began visiting an otolaryngologist for examinations, during which I underwent Auditory Brainstem Response (ABR) testing and MRI scans.
The doctor speculated that it might be caused by neurodegeneration.
Over the next six months, I experienced several episodes of vertigo and vomiting, and the doctor suggested it could be Meniere's disease, prescribing medication for me.
Initially, after taking the medication for one to two weeks, my symptoms improved, but they soon returned.
I changed doctors multiple times and was prescribed various medications including steroids, diuretics, and vestibular suppressants.
Each time, the medication would provide relief for about two weeks before the symptoms recurred, and taking the same medication again did not help.
I have since switched doctors and medications again, and my current doctor has given me a chronic prescription for two months, but there has been no improvement.
Currently, I experience dizziness about twice a week, and during severe episodes, I also vomit and need to lie down completely for a few hours to feel better.
When I am not experiencing an episode, I often feel weak and disoriented.
The tinnitus frequently becomes very loud and sharp, and I feel my hearing is deteriorating.
I am often awakened at night by loud tinnitus, as if someone is screaming in my left ear.
I am unsure if it is due to the medication, but sometimes during episodes, the sensation is not a full 360-degree spin, but rather a bobbing motion like a seesaw, and I feel uncomfortable with louder sounds.
Recently, I noticed that when I yawn, I hear a wave-like sound in my ear and experience dizziness (not vertigo).
If I plug my left ear and then release it, I also feel dizzy.
My body often does not warn me when I will feel dizzy, lightheaded, or nauseous.
I am unsure what has caused my condition to develop this way and if there are any ways to improve or treat it.
Additionally, I previously paid for a health check that included an MRI, which showed suspected nasopharyngeal polyps or adenoid hypertrophy, and mild cervical spondylosis and degeneration at the C5-C7 vertebrae.
Two years prior to my dizziness episodes, I experienced severe neck and shoulder pain.
I have been seeing otolaryngologists and even psychiatrists, and while my sleep quality has improved with medication, my condition has not.
I am wondering if I should consider seeing a neurologist instead, or if you have any suggestions for me.
Is it possible that some underlying disease is causing my current condition? I would greatly appreciate your guidance, and thank you very much for your assistance!

Hui, 40~49 year old female. Ask Date: 2023/12/23

Dr. Peng Shiwei reply Neurology

You should seek medical treatment at a neurology outpatient clinic for your symptoms.
Thank you.

Reply Date: 2023/12/23

More Info

Persistent dizziness can be a complex and frustrating condition, especially when it is accompanied by other symptoms such as hearing loss, tinnitus (ear ringing), and a sensation of fullness in the ear. Based on your description, it seems you have been experiencing a range of symptoms that may be related to Meniere's disease, a disorder of the inner ear that can affect hearing and balance. However, the persistence and recurrence of your symptoms, despite various treatments, suggest that a more comprehensive evaluation may be necessary.

Possible Causes of Your Symptoms
1. Meniere's Disease: This condition is characterized by episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear. The exact cause is not well understood, but it is believed to be related to fluid buildup in the inner ear. Treatment often includes dietary changes (such as reducing salt intake), medications (like diuretics), and sometimes injections or surgery in severe cases.

2. Vestibular Disorders: Other vestibular disorders, such as vestibular neuritis or labyrinthitis, could also be contributing to your symptoms. These conditions often follow a viral infection and can cause dizziness and balance issues.

3. Cervical Vertigo: Given your history of severe neck pain and cervical spine issues, it is possible that cervical vertigo could be a factor. This condition arises from neck problems that affect balance and can lead to dizziness.

4. Neurological Issues: The MRI findings you mentioned, such as suspected nasopharyngeal polyps or cervical spine degeneration, could potentially contribute to your symptoms. While these findings may not directly cause dizziness, they could be related to other underlying issues that need to be addressed.

5. Medication Side Effects: The medications you have been taking, including steroids and diuretics, can have side effects that may contribute to dizziness or exacerbate existing symptoms. It is essential to discuss any potential side effects with your healthcare provider.

Treatment Options
1. Consult a Neurologist: Given the complexity of your symptoms and the lack of improvement with current treatments, it may be beneficial to consult a neurologist. They can evaluate for any neurological conditions that may be contributing to your dizziness and recommend appropriate tests or treatments.

2. Vestibular Rehabilitation Therapy (VRT): This is a specialized form of physical therapy designed to help improve balance and reduce dizziness. A trained therapist can develop a personalized program to help you manage your symptoms.

3. Medication Review: A thorough review of your current medications with your healthcare provider may help identify any that could be contributing to your symptoms. Adjusting dosages or switching medications may provide relief.

4. Lifestyle Modifications: Implementing lifestyle changes, such as a low-salt diet, staying hydrated, and managing stress, can help reduce the frequency and severity of Meniere's disease symptoms.

5. Regular Monitoring: Given your history of fluctuating symptoms, regular follow-ups with your healthcare provider are crucial. This will allow for ongoing assessment and timely adjustments to your treatment plan.

Conclusion
Persistent dizziness can stem from various causes, and it often requires a multidisciplinary approach for effective management. Given your complex history, including ear issues, neck pain, and neurological findings, it is essential to work closely with your healthcare team to explore all potential avenues for treatment. A neurologist's evaluation, along with vestibular rehabilitation, may provide you with the relief you seek. Remember to communicate openly with your healthcare providers about your symptoms and any changes you experience, as this information is vital for tailoring your treatment plan effectively.

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