Hello I’m a 21 yo male in the USA. Sorry for the long post in advance. About 4 months ago I would get random dizzy spells usually they would happen after work. Or in a car typically at night time. I’m not sure how to explain the feeling but basically it felt like my eyes couldn’t focus on anything and my eyes where dizzy. That feeling would go away in 30 minutes or so and I thought nothing of it. Then about a month later I was at work and suddenly I got a dizzy spell that got worse and worse and worse. I had to leave early and went to the ER. They did a CT scan of my head, blood tests, urine test and some cognitive test. Everything was perfect. Since then I’ve been constantly dizzy, the moment I wake up I get suddenly dizzy not like I’m going to fall over. More like my eyes just don’t seem to be working properly. I’ve noticed my symptoms seem to get worse In busy places like a grocery store or like a arcade or at my job (jewelry store)It’s so hard to put into words how I’m feeling but I’ve been to so many doctors now from a cardiologist who did a ultrasound on my heart (all good). A neurologist who said it isn’t my brain. To a ENT who did a hearing test a few balance tests and tested the nerves in my ears. I’ve also been tested for BPPV which was fine as well. I’m losing hope and don’t know what to do I get passed from doctor to doctor with still no answers. I’m really hoping someone can help me. It’s a struggle to go to work and hang out with friends. I feel so tired after just simply working. Please someone help me with past experiences or any ideas as to what this might be cause this is making me miserable
21 and can’t live a normal life please help! - Pain Concern
21 and can’t live a normal life please help!
Hi Dillan, sorry to hear of your problems and worries. This isn't something i've experienced but my immediate thought through reading your post was that you dont mention if you've seen an optician. That would be my first port of call if i had a problem with my eyes. xx
How would I go to a optician? Do I call them or do I need to go to my doctors to get a referral?
In the uk we just make an appt with the optician. I'm not sure of the procedure in the US but you would want to see an Opthalmologist. I hope that helps 😊 xx
Optometrist is another word for optician and initially that is who you should make an appointment to see. You should be able to make appointment without needing referral from doctor.
Dillan, I'm from the USA as well and normally your pc would refer you out to someone else. Just call your doctor's office and ask if you'd need a referral. Good luck, I hope you feel better soon.
If it were me I'd try a referral to a migraine specialist. I have a friend who experiences your sort of symptoms, except she has to lie down sometimes with the dizziness and sometimes vomits. She was tested for Meniers disease and finally diagnosed with vestibular migraines. Good luck.
I had similar problems. Felt as if I was sea sick. Eventually diagnosed as vestibular disorder. After lots of physiotherapy and a daily regime of exercises there was great improvement. Also was told not to use bifocal glasses.
I don't think Lens Crafters is the kind of place to deal with what you have. They deal primarily with vision but don't go beyond that. I am surprised that your ENT didn't refer you to an Audiologist. I was sent to one and he did all kinds of tests. I do have BPPV which fortunately is easy enough to solve. I'm fairly certain you will need a referral, though it depends on your insurance. I am also in the US and understand how it works with our medical system. This site has members from many different countries a lot of which are in the UK. Their medical system works very different then ours. If I can be of any more assistance please don't hesitate to ask.
What is a audiologist? And I called my insurance and they got me in with a eye doctor next month so let’s see how that goes and thank you!!
Hi Dillan, sorry to hear of your problems and worries. As a mum of a 22 year old son and with a doctors background, I always worry about his neck deformation seeing how much time he spends bending it while using his mobile phone or psp. I don’t know about you but I think it’s very common for your generation and if there’s a case, it could be an early impact of it. I would recommend you to check your neck with orthopedic surgeon and vessels by doing a Doppler of carotid arteries. A back, shoulders and neck massages and physio, as well as meditation, yoga, walking and swimming definitely would help with tension. I wish you to found what is making your life difficult or your dizziness just leave you alone in one day and let you enjoy your life without it. Bless you!
How would I ask my doctor to refer me to a person like that? Cause I never even thought of it possibly being my neck
Dizziness has many possible aetiologies. The most common are vestibular, cardiovascular, neurological, and psychogenic. [6] Patients may use the term dizziness to describe vertigo, presyncope, lightheadedness and imbalance (disequilibrium). Vertigo is a sensation of distorted self-motion, occurring at rest or during an otherwise normal head movement. [1] Vertigo usually indicates a problem with the peripheral (inner ear, vestibular nerve) or central (brainstem, brain) vestibular system. [7] Imbalance may be neurological in origin and lightheadedness and presyncope may be cardiovascular in origin. Patients with psychogenic dizziness report a variety of symptoms, such as rocking, floating, or swimming sensations. [3]
However, these symptoms may overlap substantially and patients most often report feeling off-balance or unsteady. Over 60% of patients experience more than one type of dizziness. [2] Evaluating the timing and triggers of dizzy episodes can help the clinician make a correct diagnosis. [8]
Vestibular
Benign positional paroxysmal vertigo (BPPV) is the most common cause of vertigo, affecting 107 people in 100,000 per year. [9] In the US, BPPV is diagnosed in 17% to 42% of patients presenting with vertigo. [10] Prevalence increases with age and women are affected more frequently than men. [4] [11]
BPPV is caused by loose otoconia particles (calcium carbonate crystals) in the semi-circular canals, usually the posterior canal. [10]
Patients experience vertigo with changes in head position relative to gravity (e.g., rolling over in bed or looking up).
Torsional, upbeating nystagmus provoked by the Dix-Hallpike manoeuvre is diagnostic of posterior semicircular canal BPPV. [10]
Labyrinthitis is an acute bacterial or viral infection of the labyrinth of the inner ear. The patient often presents after an upper respiratory infection or acute otitis media. Patients may have associated symptoms of tinnitus and hearing loss, because the cochlea is located within the bony labyrinth. [12] Patients with acute otitis media may also report otalgia, otorrhoea and fever. [13]
Vestibular neuritis (neuronitis) is an acute peripheral neuropathy probably due to reactivation of a viral infection (e.g., herpes simplex virus), which affects the vestibular nerve. Patients present with acute onset vertigo but do not have hearing loss or tinnitus. Changes in head position exacerbate symptoms and loss of balance is a prominent feature. [12]
Meniere's disease: occurs in 1% of the population and affects all ages. [14] It is idiopathic but is associated with endolymphatic hydrops. Meniere's disease is characterised by episodic vertigo, fluctuating hearing loss, tinnitus, and aural pressure or fullness. [14]
Superior semi-circular canal dehiscence: characterised by episodes of vertigo associated with loud sound and/or altered middle-ear pressure. Patients have hyperacusis to bone-conducted sounds and a conductive hearing loss; acoustic reflexes are normal. Patients may also describe autophony, the sensation of hearing their own voice abnormally loudly. [15]
Many patients with superior semi-circular canal dehiscence present after head trauma and are initially diagnosed with post-traumatic vertigo, labyrinthine concussion, or perilymphatic fistula.
Perilymphatic fistula: an abnormal communication between the perilymph-filled space of the inner ear and an air-filled space in the middle ear, mastoid or cranium. [16] The fistula develops in the round or oval window. It may occur after stapes surgery, head trauma or barotrauma. It is characterised by episodic vertigo and fluctuating sensorineural hearing loss. [16]
Cholesteatoma is a mass of keratinising squamous epithelium within the middle ear or temporal bone. Patients may present with vertigo. [17] Associated symptoms include otorrhea and hearing loss. [18]
Patients who have had previous mastoid surgery with a mastoid cavity are prone to dizziness with an ear infection.
Persistent postural-perceptual dizziness (PPPD): a chronic vestibular disorder. Five diagnostic criteria must be satisfied to make the diagnosis: [19]
One or more symptoms of dizziness, unsteadiness, or non-spinning vertigo present on most days for 3 months or more.
Persistent symptoms occurring without provocation but exacerbated by upright posture, active or passive motion, or exposure to moving stimuli.
Disorder precipitated by conditions that cause vertigo including acute, episodic, or chronic vertigo or neurological or medical illness, or psychological distress.
Symptoms cause significant distress or functional impairment.
Symptoms are not better accounted for by another disease or disorder.
Neurological
Vestibular migraine is one of the most common causes of vertigo and dizziness. It often occurs in patients with a personal or family history of migraine. [20] Associated symptoms include headache, photophobia, phonophobia, nausea and fatigue. Episodes last minutes to days. [7]
Posterior fossa tumours: include vestibular schwannomas (acoustic neuroma), meningiomas, cerebellar or brainstem tumours, and epidermoid cysts. May cause hearing loss and/or cranial nerve palsies.
Multiple sclerosis: vertigo is an initial symptom in 5% of patients and occurs in 50% at some point during the disease. Prolonged spontaneous attacks of vertigo occur if a demyelinating plaque occurs at the root entry zone of the vestibular nerve or nucleus, and this presents as an acute peripheral vestibular disorder, such as vestibular neuritis. [3]
Posterior circulation stroke: may be due to infarction or haemorrhage. One in five strokes affects the posterior cerebral circulation: the vertebral, basilar and posterior cerebral arteries and their branches. [21]
Symptoms are variable and often non-specific, however dizziness is one of the most common presenting symptoms. Vertigo is continuous and prolonged. Other common presenting symptoms include unilateral limb weakness, dysarthria, headache, diplopia, nausea and vomiting. [21] [7] The presentation may be very similar to vestibular neuritis.
Patients may have at least one vascular risk factor (age >60 years, hypertension, diabetes, smoking, obesity). [7]
Signs include nystagmus, unilateral limb weakness, gait ataxia, unilateral limb ataxia, dysarthria, facial numbness, Horner’s syndrome and diplopia. [21] [7] Patients usually cannot stand without support, even with the eyes open, whereas patients with acute vestibular neuritis or labyrinthitis are usually able to do so.
Lateral medullary infarction (Wallenberg’s syndrome) is caused by occlusion of the ipsilateral vertebral artery that supplies the posterior inferior cerebellar artery. Patients have prolonged vertigo lasting several days. Signs include: truncal ataxia, ipsilateral limb ataxia, diplopia, multidirectional nystagmus, ipsilateral Horner’s syndrome ipsilateral facial pain, hoarseness, dysphagia and loss of pain and temperature sensation of the ipsilateral face and contralateral trunk and limbs. [22] [21]
Vertebrobasilar insufficiency: describes transient ischaemia of the vertebrobasilar circulation. It is usually the result of atherosclerosis and affects the territory supplied by the anterior inferior cerebellar artery. Patients present with episodic vertigo, diplopia, headaches, vomiting, ataxia, blindness, imbalance and bilateral weakness. [23] Patients may experience drop attacks, sudden falls secondary to loss of limb tone without loss of consciousness. Episodes last between 30 seconds and 15 minutes and typically start after abruptly standing or turning the head. [23]
Vertebral artery dissection: may be traumatic or spontaneous and is a cause of posterior circulation stroke in young adults. Symptoms include headache, dizziness, and neck pain and signs include ataxia and dysarthria. [24] Predisposing factors are hypertension, history of recent infection and certain connective tissue disorders (Ehlers-Danlos syndrome, Marfan’s syndrome, osteogenesis imperfecta, and fibromuscular dysplasia). [25] [26]
Arnold-Chiari malformation type 1: an abnormality of the base of the skull, associated with brain stem and cerebellum herniation through the foramen magnum into the spinal canal. The most common symptom is occipital headache. Other symptoms may include dizziness, unsteadiness, and hearing loss. [27] Symptoms can mimic those of BPPV. [28] The condition might be asymptomatic.
Idiopathic intracranial hypertension (pseudotumor cerebri): characterised by raised intracranial pressure that is not caused by a mass lesion; associated with headache and transient poor vision. These patients are often obese and complain of clumsiness, imbalance, and dizziness rather than true vertigo. Some patients present with bilateral sixth nerve palsy or tinnitus. Incidence is increasing with the rise in obesity. [29]
Normal pressure hydrocephalus: associated with normal intracranial pressure and enlarged ventricles (hydrocephalus). Patients present with ataxia, urinary incontinence, and cognitive dysfunction. [30] The diagnosis may be difficult to establish.
Mal de debarquement syndrome: patients experience swinging, swaying, unsteadiness, and disequilibrium after exposure to motion. There may be a history of a long voyage or air travel. It is thought to be due to a conflict between the sensory inputs from the visual, vestibular, and somatosensory systems and the central vestibular nuclei, cerebellum, and parietal cortex.
Paraneoplastic cerebellar degeneration: a rare complication of cancer of the ovary, breast, or lung, or of Hodgkin's lymphoma. Auto-antibodies are thought to be directed against Purkinje cells. The anti-Yo antibody can present years before tumour detection. Anti-Tr antibody is associated with Hodgkin's lymphoma.
Secondary syphilis may present with bilateral sensorineural hearing loss or vertigo. Late neurosyphilis may present with hearing loss, fluctuating hearing, or vestibular symptoms. [31]
Cardiovascular
Dizziness may be associated with palpitations or provoked by exercise if there is a cardiovascular cause. [32] Dizziness with a cardiovascular aetiology may cause presyncope and/or vertigo. [33] Nearly two thirds of of patients with cardiovascular causes of dizziness report vertigo, and vertigo is the only type of dizziness described in 37% of these patients. [33]
Pre-syncope is lightheadedness without an illusion of movement. Symptoms include generalised weakness, giddiness, headache, blurred vision, and diaphoresis. Symptoms last few seconds to a few minutes. The patient senses an impending loss of consciousness but recovers before losing consciousness. [34]
The mechanism is almost always a reduction in blood supply to the brain. The symptoms may be spontaneous, positional, or associated with various triggers, depending on the cause. [3]
Presyncope is the most common subtype of dizziness in older people. [32]
Orthostatic (or postural) hypotension is one of the most common causes of presyncope. Patients complain of dizziness on standing. [35] The cause is impaired peripheral vasoconstriction and/or a reduction in intravascular volume. It is defined as a decrease in systolic blood pressure (BP) of ≥20 mmHg or a decrease in diastolic BP of ≥10 mmHg within 3 minutes of standing. [36] One study has suggested that BP should be tested within 1 minute of standing. [37]
Orthostatic hypotension may occur in patients who take antihypertensive medication or who are volume depleted.
It may be idiopathic or associated with autonomic dysfunction, such as in people with Parkinson's disease, multiple system atrophy or diabetic autonomic neuropathy. Orthostatic hypotension is a recognised complication after bariatric surgery. [38]
Arrhythmias, ischaemia, structural heart disease and pulmonary embolism may also cause presyncope. [34]
A study of 881 patients who attended the emergency department complaining of pre-syncope found that 5% had serious outcomes within 30 days of the index visit. Most patients with a cardiac cause for pre-syncope were diagnosed at the initial emergency department visit. The most common cardiac causes detected in this study were atrial fibrillation and sinus node dysfunction. [34]
Other cardiac causes of presyncope detected in the study population were: supraventricular tachycardia, complete atrioventricular block, myocardial infarction, ventricular arrhythmia, pulmonary embolism and structural heart disease. [34]
A study of patients undergoing monitoring for undiagnosed syncope found that an arrhythmia was present in 25% of presyncopal events. [39]
Postural orthostatic tachycardia syndrome: the most common autonomic disorder in young people. The patient has similar postural symptoms to people with orthostatic hypotension but with excessive postural tachycardia. Patients commonly present with complaints of postural lightheadedness, or dizziness. This is diagnosed by increased heart rate on standing, lack of orthostatic hypotension, and the absence of other conditions, such as dehydration, a primary cardiac cause, an endocrine disorder, or a nervous system disorder. [40]
Psychological
Psychophysiological dizziness (mixed physiological and psychogenic aetiology): may occur spontaneously or after a labyrinthine disorder. Patients complain of a variety of symptoms, such as rocking, floating, or swimming sensations. The symptoms may worsen with stress or fatigue. [3]
Primary hyperventilation is alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. Patients are usually young and female. Over half have a comorbid psychiatric condition. Fear, paraesthesia and dizziness are the most common symptoms. [41]
Psychogenic dizziness: panic disorder with agoraphobia, personality disorders, or generalised anxiety are often present in patients complaining of dizziness. If the dizziness is psychogenic, patients may demonstrate inappropriate or excessive anxiety or fear. Phobic postural vertigo is characterised by dizziness in standing and walking despite normal clinical balance tests. Patients may demonstrate anxiety reactions and avoidance behaviour to specific stimuli. [42]
Phobic postural vertigo is characterised by dizziness in standing and walking despite normal clinical balance tests. Patients may demonstrate anxiety reactions and avoidance behaviour to specific stimuli. [42]
Metabolic
Diabetes mellitus: dizziness may be associated with episodes of hypoglycaemia. Other features symptoms of hypoglycaemia include shakiness, sweating, irritability, confusion, tachycardia, and hunger. [43] Diabetic patients with peripheral neuropathy may have more difficulty in recovering from a peripheral vestibular disorder. [44]
Autoimmune
Systemic lupus erythematosus: patients may complain of vertigo or hearing loss and may have abnormal nystagmography. [45] [46]
Cogan's syndrome: an inflammatory disorder resulting in interstitial keratitis and audiovestibular dysfunction. The pathology involves plasma cell and lymphocyte infiltration of the spiral ligament, endolymphatic hydrops, and degenerative disease of the organ of Corti. There is also demyelination of the eighth cranial nerve and inner ear osteogenesis. [47]
Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis): characterised by granulomatous lesions of the upper respiratory tract, necrotising vasculitis, and glomerulonephritis. [48]
Behcet's disease: a rare systemic autoimmune vasculitis, characterised by recurrent oral and genital ulceration, ocular inflammation and skin lesions. 15% to 47% of patients with Behcet's disease have vestibular involvement. This may cause dizziness, nystagmus and high-frequency sensorineural hearing loss. [49]
Drug related
Ototoxic drugs: aminoglycoside antibiotics such as gentamicin and neomycin are vestibulotoxic and cochleotoxic. [50]
Ototoxicity has been described for topical as well as parenteral use. [51]
Aminoglycosides may cause vertigo without causing hearing loss. Toxicity with parenteral use is related to the total dose administered.
The risk factors for ototoxicity are age >60 years, high serum drug levels, previous sensorineural hearing loss, concomitant renal impairment, attendant noise exposure, duration of therapy >10 days, and simultaneous administration of other ototoxic agents, such as loop diuretics or aspirin.
Some patients have a mitochondrial DNA mutation which predisposes them to ototoxicity following aminoglycoside exposure. This mutation accounts for 33% to 59% of aminoglycoside ototoxicity. [52]
Chemotherapeutic drugs: cisplatin, widely used in various soft-tissue neoplasms, may cause sensorineural hearing loss and tinnitus. [53] The severity of the sensorineural hearing loss is related to the cumulative dose.
Alcohol: patients report feeling 'high', dizzy, and intoxicated after ingestion. [54]
Other drugs: antihypertensive medication, anaesthetic medication, antiarrhythmic medication, and drugs of abuse may cause patients to feel dizzy. Some antiepileptic drugs, such as oxcarbazepine and topiramate, increase the risk of balance disorders. [55]
Alpha-adrenoreceptor blockers, beta-blockers, nitrates, antipsychotics, opioids, antiparkinsonian drugs, and phosphodiesterase inhibitors may be associated with orthostatic hypotension. [56] [54] [57]
Toxins
Carbon monoxide poisoning: may be secondary to accidental exposure from residential boilers, central heating systems, cookers, fireplaces and chimneys. The symptoms are often non-specific but may include vertigo, headaches, impaired concentration, presyncope, tachycardia, or angina. [58]
Traumatic
Post-traumatic vertigo: generally occurs as a result of blunt head trauma. Patients may present with symptoms of BBPV, a traumatic perilymphatic fistula, post-traumatic Meniere's disease or post concussion syndrome. [59] Acute symptoms of concussion include headache, imbalance, fatigue, sleep disturbance, impaired cognition, photophobia and phonophobia. [60]
I don’t know much about you and if your doctor missed something or you haven’t mentioned, this guideline might help you to find a clue
Wow that was a lot to read but super helpful and I really appreciate it very much. After reading literally everything it sounded more like this is connected to my ears I think I need to see a new ENT specialist and hopefully they will take me more seriously and go more in depth
Good luck , Dillan🍀 and get better soon!
HiI'm sorry you are having such a rotten time. Yes, I would definitely go to optician. Also, have your ears been tested, not just for hearing but balance as well. It could be something like vertigo or labyrinthitis which there are meds for. Hope you get sorted soon.
Take care. Lynne 😊
I’m going to a optician next month. And how would they check my ears balance? I’ve done the move on a table for BPPV which was negative and they’ve checked my balance and it’s been a little off but that’s being caused by whatever is causing dizziness
HiGlad you've got an appointment. I should have said ask your Dr to refer you to ENT for your balance.
Labyrinthitis is caused by a virus so may not show up with different specialists. Have you tried travel sickness meds or something called stemil tablets. They can be very effective. Has anyone suggested this as a diagnosis?I had a couple of years of regular bouts of labyrinthitis and can be quite debilitating. Then suddenly stopped and never had a problem since.
Hey Dillan, sorry to hear this; have you considered POTS (postural orthostatic tachycardia syndrome)? I think it can be influenced by stress which might be related to the public places triggering it etc.
I have seen stuff about it. But it doesn’t seem too fitting with some of my symptoms. I know with POTS. Your heart beats pretty fast when standing up and I’ve tested my heart when standing and it barely elevates in bpm
Oh okay, no problem, well I hope whatever it is gets diagnosed soon! All the best 
Hi Dillan, I started to suffer with unexplained dizziness and vision problems, diplopia, among many other strange symptoms about 14 years ago. It was really frightening and it ended my career and I lost my independence so I can understand how upsetting this can be.
I saw so many different consultants and felt like I was getting nowhere over the years until I saw a Professor of Neurology and he said it was a very unusual form of migraine without the headaches, though I did suffer from migraines as a young girl.
I was started on Pizotifen which worked great for 4 years then my symptoms returned. I returned to the neurology dept after much research myself and asked to try Topamax (Topiramate) which is a drug used for epilepsy and I’ve been great every since. I’m on a low dose and have option of increasing if I need to, which I have twice but always managed to reduce again. I’m sorry I don’t know the name of these in USA.
I hope my story has helped. I remember well the awful feeling of walking into a shopping centre, it made me so ill. I couldn’t cope with any busy environments from patterned carpets, leaves on a road, cluttered rooms. My whole home had to be completely minimalistic and I became housebound for 3 years until I got the help I needed.
I wish you all the luck in the world and hope you get some help, there are various forums on Facebook which are helpful too. Take care.
Hi Dillan, I agree that you should see an audiologist and have a hearing test ( livingsounds.ca/ ) to see if it is related to losing ear balance. It is difficult to diagnose a condition and requires a thorough understanding. Because you are so young, let us hope that the doctors can find out what is wrong with you and help to cure you. Hope you get well soon.
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