Persistent Dizziness and Throat Foreign Body Sensation: Next Steps in Diagnosis

Dizziness and a sensation of a foreign body in the throat?

I have been experiencing dizziness for the past two years.
The symptoms include feeling dizzy all day, a heavy sensation in my head, and a sense of imbalance, particularly in the back of my head.
Initially, I also had symptoms of palpitations and sweating, but those have since resolved, while the dizziness persists.
I have undergone several tests, including MRI of the brain, ECG, EEG, neck and chest X-rays, thyroid ultrasound, blood tests, electromyography, nasal endoscopy by an ENT specialist, and balance function tests.
Currently, only the electromyography showed abnormalities (in the electrode testing), while all other tests were normal, including evaluations by a psychiatrist.
I have tried medication without improvement.
My job requires me to rotate between day and night shifts every four months, and I still experience dizziness during the day shifts.
Could you please advise me on what steps I should take next? I am also wondering if this could be related to a sensation of a foreign body in my throat.

Xiao Fang, 20~29 year old female. Ask Date: 2016/01/17

Dr. Gao Chunde reply Neurology

The tests related to dizziness, palpitations, and sweating seem to be normal.
I can't think of any further questions.
However, if dizziness is accompanied by a sensation of a foreign body in the throat, it may sometimes be a manifestation of increased tension in the nervous system.

Reply Date: 2016/01/17

More Info

Persistent dizziness can be a complex symptom that often requires a multidisciplinary approach to diagnosis and management. Given your extensive medical history, including the various tests you've undergone, it seems that you've already ruled out many common causes of dizziness. However, the persistence of your symptoms, particularly the sensation of dizziness for two years, warrants further investigation.

Next Steps in Diagnosis
1. Neurological Evaluation: Since you have already undergone MRI and EEG, it might be beneficial to consult a neurologist again, especially if your symptoms have evolved or worsened. They may consider additional tests such as a tilt table test to assess for orthostatic hypotension or other forms of dysautonomia.

2. Vestibular Assessment: Given that you have experienced dizziness and balance issues, a thorough vestibular evaluation may be warranted. This could include specialized tests such as videonystagmography (VNG) or vestibular evoked myogenic potentials (VEMP) to evaluate the function of your inner ear and balance system.

3. Cardiovascular Assessment: Although your heart-related symptoms have subsided, it may be worthwhile to have a cardiologist evaluate your heart function further, particularly if you experience any episodes of dizziness that correlate with changes in posture or activity levels.

4. Psychological Evaluation: Since you mentioned having seen a psychiatrist, it may be beneficial to revisit this aspect. Chronic dizziness can sometimes be exacerbated by anxiety or stress, and addressing any underlying psychological factors may help alleviate your symptoms.

5. Throat Sensation: The sensation of a foreign body in the throat could be related to several factors, including gastroesophageal reflux disease (GERD), muscle tension, or even anxiety. An evaluation by an otolaryngologist (ENT specialist) may help determine if there is any physical cause for this sensation. They may perform a laryngoscopy to visualize the throat and esophagus.

6. Lifestyle Modifications: Given your work schedule involving rotating shifts, it may be beneficial to assess your sleep hygiene and overall lifestyle. Sleep disturbances can significantly impact dizziness and overall well-being. Strategies to improve sleep quality, such as maintaining a consistent sleep schedule, reducing caffeine intake, and creating a relaxing bedtime routine, may be helpful.

7. Physical Therapy: Vestibular rehabilitation therapy (VRT) can be effective for managing dizziness and balance issues. A physical therapist specializing in vestibular disorders can provide exercises tailored to your specific needs, which may help improve your balance and reduce dizziness.

Conclusion
In summary, while you have undergone a comprehensive evaluation, the persistence of your dizziness and throat sensation suggests that further investigation is warranted. A multidisciplinary approach involving neurologists, ENT specialists, and possibly physical therapists may provide a clearer understanding of your symptoms and lead to effective management strategies. Additionally, addressing lifestyle factors and psychological well-being can play a crucial role in your overall health. Always ensure to communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will aid in tailoring the best approach for your situation.

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