Is My Dizziness Due to Positional Vertigo? Ear Symptoms

Are my symptoms indicative of positional vertigo?

Hello Dr.
Tsai,
My name is Keith, and I am from Canada, currently studying electrical engineering at university.
Since last summer, I have been experiencing intermittent mild dizziness, which varies in intensity.
The dizziness I feel is not a spinning sensation; rather, it feels as if I am about to fall to my left side.
After some time, I also noticed some abnormal sensations in my left ear.
When I yawn, I can feel both eustachian tubes opening simultaneously.
If I experience a feeling of fullness, gently holding my breath helps alleviate it.
However, during this period of dizziness, I feel that my left eustachian tube has been unable to "open" normally, and even holding my breath forcefully does not provide much relief, resembling the sensation of eustachian tube swelling during a cold.
Sometimes, I experience unexplained soreness near the jaw joint below my left ear, and it feels as if my left ear is suddenly "blocked"; although I can hear sounds, they are quieter than those perceived by my right ear.
Initially, I thought it might be due to allergies, but after using an antihistamine spray for a while, my condition did not improve.
I have been feeling foggy for over six months, during which I consulted several ENT specialists, but none provided a resolution.
The ENT doctor I saw performed a nasal endoscopy and noted allergic phenomena in the nasopharynx but found no serious issues.
The hearing tests and tympanometry I underwent were generally normal.
Later, due to unbearable dizziness, I consulted a neurologist, but the doctor did not perform any scans and merely prescribed some sleeping pills, which left me feeling frustrated and lost, and disheartened with the Canadian healthcare system.
Sometimes, I find it difficult to sleep at night due to dizziness, and the lack of sleep the next day exacerbates the dizziness, creating a vicious cycle.
Some doctors have suggested that I might have "positional vertigo" and that a virus could have invaded my cochlea.
However, I feel that the strange sensations in my left ear are directly related to the dizziness I have been experiencing.
Therefore, I would like to ask Dr.
Tsai to clarify whether I truly have positional vertigo or if there might be another underlying cause.
If it is indeed positional vertigo, what could be causing the strange sensations in my left ear?
P.S.
I have a history of dust mite and pollen allergies and suffered a concussion at the age of twelve.

Keith, 10~19 year old female. Ask Date: 2004/03/04

Dr. Cai Zhenggu reply Otolaryngology

Hello Keith, based on your description, you are indeed experiencing positional vertigo.
This is a symptom caused by otoliths floating in the lymphatic fluid and coming into contact with the posterior semicircular canal.
Adjusting your head position and taking oral medication can help improve the condition.

Reply Date: 2004/03/04

More Info

Hello Keith,
Thank you for sharing your concerns regarding your dizziness and ear symptoms. Based on the information you've provided, it does sound like you may be experiencing symptoms consistent with positional vertigo, specifically Benign Paroxysmal Positional Vertigo (BPPV). This condition is characterized by brief episodes of dizziness that occur with changes in head position. It is often caused by small calcium carbonate crystals (otoconia) that become dislodged from their usual location in the inner ear and migrate into one of the semicircular canals, leading to abnormal signals being sent to the brain when the head is moved.

Your description of feeling as if you are going to fall to the left side, along with the sensation of your left ear feeling "blocked" or not functioning properly, aligns with common symptoms of BPPV. The fact that you experience relief when you hold your breath or change positions suggests that your symptoms may indeed be positional in nature. Additionally, the discomfort in your left ear and the associated jaw pain could indicate that there is a connection between your ear and the vestibular system, which is responsible for balance.

The sensation of fullness or pressure in the ear, especially when yawning or trying to equalize pressure, could be related to Eustachian tube dysfunction. This occurs when the tube that connects the middle ear to the back of the throat does not open properly, leading to a feeling of pressure or fullness. Allergies, as you mentioned you have a history of dust mite and pollen allergies, can contribute to this dysfunction by causing inflammation and swelling in the nasal passages and Eustachian tubes.

Given that you have undergone hearing tests and pressure tests that returned normal results, it is reassuring that there is no significant damage to your hearing or major issues with your ear structure. However, the persistent nature of your symptoms, especially the dizziness and ear discomfort, warrants further investigation. It may be beneficial to consult with an otolaryngologist (ear, nose, and throat specialist) who can perform specific tests to diagnose BPPV or other vestibular disorders accurately.

In terms of management, if BPPV is confirmed, there are specific maneuvers, such as the Epley maneuver, that can help reposition the dislodged crystals in your inner ear, alleviating the dizziness. Additionally, addressing any underlying allergies with appropriate medications or therapies may help relieve the Eustachian tube dysfunction and improve your ear symptoms.

It's understandable to feel frustrated with the healthcare system, especially when you are not receiving clear answers or effective treatment. It’s important to advocate for your health and seek a second opinion if necessary. Sometimes, a multidisciplinary approach involving both an ENT specialist and a neurologist may provide a more comprehensive understanding of your symptoms.

In summary, your symptoms could indeed be related to positional vertigo, possibly compounded by Eustachian tube dysfunction due to allergies. I recommend seeking further evaluation from an ENT specialist who can provide targeted treatment options. Remember to keep track of your symptoms and any triggers, as this information can be invaluable in guiding your healthcare provider toward an accurate diagnosis and effective treatment plan.

Wishing you the best in your journey toward better health.

Best regards,
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