Dizziness: Navigating ENT and Neurology Challenges

Dizziness and helplessness?

Doctor, I have discomfort in my shoulders and neck.
After I first visited a traditional Chinese medicine practitioner for cupping therapy on my shoulders and neck in early November last year, I experienced palpitations and dizziness a few days later.
I immediately stopped taking the herbal medicine, and the palpitations disappeared, but the dizziness has persisted.
My dizziness feels like my body is swaying up and down, not a spinning sensation.
It is particularly noticeable when I wash my face or hands and shake my legs, but I don’t feel anything unusual when lying down or sitting.

Later, I went to the Veterans General Hospital to see a neurologist and underwent three tests.
The reports are as follows: A.
Ocular Motility Test: 1.
Saccade: Normal 2.
Smooth Pursuit: Normal 3.
OKN Test: Normal B.
Spontaneous Nystagmus: Absent C.
Caloric Test: Abnormal Response: Canal Paresis (31%) DP (37%).
The doctor said I have inner ear imbalance and advised me to see an otolaryngologist.

When I visited the ENT specialist, the doctor reviewed the neurologist's test results and asked me questions.
He said I seemed to have no significant issues but prescribed Suzin (a vasodilator) for me to take for two weeks.
After finishing the medication with no improvement, I took my records to Mackay Memorial Hospital to see another ENT doctor.
He said I should consult a neurologist, and after reviewing the reports, he prescribed FLUDIAZEPAM, a sedative, for me to take as needed.
I have been taking one pill during the day for a month now without stopping.
I then returned to the Veterans General Hospital and switched to a different neurologist.
I tearfully expressed my frustration, saying that the ENT doctor found no issues, but I still felt this way.
The neurologist said there were problems in the reports, indicating inner ear imbalance, and prescribed Merislon (a vasodilator).
After taking it for four weeks, there was still no improvement.

Every time I visit the neurologist, my blood pressure spikes due to anxiety, reaching around 150, and my heart rate accelerates to about 110.
However, I regularly monitor my blood pressure and heart rate at home, and they are normal.
I only feel anxious when I go to the hospital.
The neurologist arranged for intracranial blood flow monitoring due to my elevated blood pressure and heart rate, which showed mild abnormalities.
I am unsure what this test entails, but I was very anxious during the intracranial blood flow monitoring as well.
I wonder if that could have affected the results.
Doctor, I have been experiencing these issues since November last year, and there has been no improvement.
I truly don’t know what to do; I feel helpless.
I am uncertain whether I should see an ENT specialist or a neurologist.
I have been suspecting that the cupping therapy on my neck might have caused the problem because the timing is too coincidental.
I genuinely don’t know where the issue lies.
I understand that dizziness can range from minor to serious, and I am very scared that there might be problems with my brain or cervical spine.
I am considering whether I should pay out of pocket for an MRI.
I really want a doctor who can provide me with clear answers.
I just want to get better quickly.
Isn’t inner ear imbalance usually associated with spinning sensations? How long does it typically take to recover from this? I am feeling very distressed and hope the doctor can help me.

Xiao Mei, 20~29 year old female. Ask Date: 2016/01/31

Dr. Zheng Jueyi reply Otolaryngology

Hello, based on the previous report, there is indeed a condition of inner ear imbalance.
If you have already been evaluated by two specialists with no other obvious abnormalities, it is recommended to improve balance and circulation through exercise.
As for medication, it can be assessed by a clinician based on symptoms.
Dizziness often takes some time to improve, and you may return for follow-up or medication adjustment.
If you are concerned about other issues causing dizziness, you may also consider a self-funded health checkup for further examination.
Wishing you peace and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/31

More Info

Dizziness can be a perplexing and distressing symptom, often leading patients to seek help from various specialists, including those in neurology and otolaryngology (ENT). Your experience of dizziness following a cupping therapy session raises several important considerations regarding the potential causes and appropriate management strategies.

Understanding Dizziness
Dizziness can manifest in various forms, including vertigo (a spinning sensation), lightheadedness, or a feeling of imbalance. In your case, you describe a sensation of your body swaying up and down, which is more indicative of a balance issue rather than classic vertigo. This type of dizziness can often be linked to problems in the vestibular system, which is responsible for maintaining balance and spatial orientation.

Possible Causes
1. Vestibular Dysfunction: The abnormal caloric test results you received suggest that there may be an issue with your inner ear, which is crucial for balance. Conditions such as vestibular neuritis or labyrinthitis can lead to dizziness and may not always present with classic vertigo.

2. Anxiety and Stress: Your report of elevated blood pressure and heart rate during medical visits indicates that anxiety may be contributing to your symptoms. Anxiety can exacerbate feelings of dizziness and create a cycle of fear and physical symptoms.

3. Cervical Issues: Given that your symptoms began after neck cupping, it’s possible that cervical spine issues could be contributing to your dizziness. Cervical vertigo can occur when there is dysfunction in the neck that affects balance.

4. Medication Side Effects: The medications you have been prescribed, including blood vessel dilators and sedatives, may have side effects that could contribute to dizziness. It’s important to discuss any ongoing symptoms with your physician to evaluate the need for medication adjustments.

Diagnostic Considerations
You mentioned undergoing several tests, including ocular motility tests and caloric testing, which are essential in assessing vestibular function. The "lightly abnormal" results from your intracranial blood flow monitoring could indicate subtle changes in cerebral circulation, but it’s crucial to interpret these findings in the context of your overall clinical picture.

If you are considering an MRI, it could provide valuable information about the structural integrity of your brain and cervical spine, ruling out any significant abnormalities that could be contributing to your symptoms.

Management Strategies
1. Vestibular Rehabilitation Therapy (VRT): This is a specialized form of physical therapy aimed at improving balance and reducing dizziness. A physical therapist trained in vestibular rehabilitation can provide exercises tailored to your specific needs.

2. Anxiety Management: Since anxiety appears to be a factor, cognitive-behavioral therapy (CBT) or other forms of counseling may help you manage stress and reduce the physical symptoms associated with anxiety.

3. Follow-Up with Specialists: It may be beneficial to continue working with both ENT and neurology specialists. If one specialist does not provide satisfactory answers, seeking a second opinion can be valuable.

4. Lifestyle Modifications: Maintaining a healthy lifestyle, including regular exercise, adequate hydration, and a balanced diet, can support overall well-being and potentially alleviate some dizziness symptoms.

Conclusion
Dizziness can stem from a complex interplay of factors, including vestibular dysfunction, anxiety, and possibly cervical spine issues. It’s essential to continue working closely with your healthcare providers to explore these avenues further. If your symptoms persist or worsen, advocating for further diagnostic testing, such as an MRI, may be warranted to ensure that no underlying conditions are being overlooked. Remember, you are not alone in this journey, and with the right support and treatment, improvement is possible.

Similar Q&A

Persistent Dizziness: Understanding Neurological Causes and Next Steps

Hello doctor, I have been experiencing dizziness since early May (it's not a spinning sensation, but I feel lightheaded all day). Initially, I thought it was heat exhaustion due to the combination of feeling hot and dizzy, but now I only have dizziness without any other symp...

Dr. Jiang Junyi reply Neurology
Hello: You mentioned that "the ENT examination includes hearing tests, balance assessments, inner ear temperature differentials, eye movement tests, and brainstem response, while the neurology examination includes awake EEG, brainstem auditory evoked potentials, and carotid ...

Understanding Dizziness and Mild Headaches: A Neurological Perspective

Hello Doctor, I started experiencing symptoms of dizziness and lightheadedness in May. I visited an ENT clinic, but it was ineffective. Then I went to Chi Mei Hospital's ENT department, where I underwent tests including a posturography, pure tone audiometry, speech audiometr...

Dr. Cai Zongzhang reply Neurology
Hello: Based on the symptoms mentioned, if the ENT examination is normal, it is recommended to visit the neurology outpatient clinic.

Understanding Dizziness: Neurological Insights and Treatment Options

Hello, physician: My father is 53 years old and experiences significant dizziness, especially when getting up in the morning and before going to bed, without accompanying tinnitus. He has a history of dizziness from May 1999, when he suddenly felt the world spinning while hiking,...

Dr. Ye Boshou reply Neurology
The manifestations of dizziness can originate from peripheral sources (such as the inner ear organs, semicircular canals, Meniere's disease, etc.) as well as central sources, such as lesions in the brainstem or cerebellum. Central ischemia, in addition to dizziness, may also...

Understanding Tinnitus and Dizziness: Insights from Neurology

Hello Dr. Jiang, the following questions are for a patient (I actually have similar symptoms myself): 1. Tinnitus, dizziness, and a sensation of noise in the head have been intermittent for 30 years (I am 56 years old this year). 2. Recently, after 8 months of continuous dizzine...

Dr. Jiang Junyi reply Neurology
Hello: Based on your description, the management of cardiovascular disease primarily involves controlling the three highs (hypertension, hyperlipidemia, and hyperglycemia), which you seem to have achieved. However, you did not mention any sleep issues, so it may be worth consider...