Persistent Dizziness and Tinnitus: Seeking the Right Specialist

Dizziness and tinnitus issues?

Hello, doctor.
Due to long-term dizziness and tinnitus, I recently underwent hearing tests and brainstem auditory evoked potential tests at an otolaryngology clinic, and the results were normal.
There are no issues with my inner ear.
The ENT specialist suggested that my tinnitus might be caused by severe nasal allergies, so I was prescribed allergy medication.
After taking the allergy medication and using a nasal spray for four days, my allergies improved, but my dizziness and tinnitus have not.
I have experienced tinnitus since childhood, which occurs when the environment is relatively quiet (though not completely silent; I can still hear sounds, but they are quieter), presenting as a sharp frequency that happens almost daily, with varying intensity.
I had surgery at the end of November last year for an ovarian luteal cyst, and I started experiencing dizziness around October of last year.
The dizziness is not a spinning sensation; rather, it feels like my head is heavy and my legs are light, and at times, I feel a slight swaying in my environment.
This has not improved to this day.
Additionally, I tend to get tired easily, and my memory is not very good, which is exacerbated by the tinnitus, making it difficult to concentrate (this was the case even before the surgery).
However, blood tests showed no anemia.
Which specialty should I consult next for further examination?

Wendy, 20~29 year old female. Ask Date: 2016/01/30

Dr. Wu Fangcan reply Family Medicine

Dizziness and tinnitus require checking blood lipids, VDRL, TPHA, and other tests.
If accompanied by high-frequency tinnitus or hearing loss, Meniere's disease should be suspected.
Long-term use of antihistamines may cause dizziness and poor sleep, and some blood pressure medications can also have dizziness as a side effect.
If there is unilateral hearing loss, an acoustic neuroma should be suspected.
It is recommended to consult a neurologist for evaluation and examination.
Thank you.

Reply Date: 2016/01/30

More Info

Persistent dizziness and tinnitus can be quite distressing, especially when initial evaluations by an ENT specialist yield normal results. Given your symptoms and medical history, it’s important to consider a multidisciplinary approach to identify the underlying cause and provide appropriate treatment.

Understanding Your Symptoms
1. Dizziness: You described your dizziness as a feeling of heaviness in the head, rather than the spinning sensation often associated with vertigo. This type of dizziness can be related to various factors, including vestibular dysfunction, neurological issues, or even anxiety.

2. Tinnitus: The persistent ringing or buzzing in your ears, especially in quiet environments, can be linked to several conditions. While it’s often associated with hearing loss, it can also be a symptom of other underlying issues, such as stress, anxiety, or even certain medications.

Next Steps in Diagnosis
Since your ENT evaluation did not reveal any abnormalities, and given that your symptoms have persisted despite allergy treatment, it may be beneficial to consult with other specialists:
1. Neurologist: Given your symptoms of dizziness, especially if they are accompanied by cognitive issues like memory problems and difficulty concentrating, a neurologist can help rule out any central nervous system disorders. They may conduct further tests, such as MRI or CT scans, to assess brain health and rule out conditions like migraines, vestibular migraines, or other neurological disorders.

2. Audiologist: An audiologist can perform a comprehensive hearing evaluation and additional tests to assess the nature of your tinnitus. They can also provide sound therapy or counseling strategies to help manage your tinnitus.

3. Allergist/Immunologist: Since you mentioned that allergies might be contributing to your symptoms, consulting an allergist could be beneficial. They can perform specific allergy tests and suggest treatment options, including immunotherapy if necessary.

4. Psychiatrist/Psychologist: If anxiety or stress is a contributing factor to your symptoms, a mental health professional can provide support and treatment options. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing chronic tinnitus and associated anxiety.

Additional Considerations
- Lifestyle Modifications: Managing stress through relaxation techniques, regular exercise, and a balanced diet can also help alleviate symptoms. Staying hydrated and avoiding caffeine and alcohol may reduce dizziness and tinnitus severity.

- Follow-Up Care: Since you had surgery for an ovarian cyst, it’s important to ensure that there are no complications from the procedure that could be contributing to your symptoms. A follow-up with your gynecologist may also be warranted.

- Comprehensive Evaluation: A thorough evaluation of your medical history, including any medications you are taking, is crucial. Some medications can cause dizziness or tinnitus as side effects.

Conclusion
In summary, your persistent dizziness and tinnitus warrant further investigation by a neurologist, audiologist, and possibly an allergist. A comprehensive approach will help in identifying the root cause of your symptoms and guide you toward effective treatment options. Remember to communicate openly with your healthcare providers about all your symptoms and concerns, as this will aid in forming a complete picture of your health.

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