Question: I am 77 years old and have always been in excellent health until six months ago, when I began to feel somewhat imbalanced when starting to serve the ball in a tennis game. I've since had an MRI, and nothing was found, although the imbalance has stayed. I was told by a chiropractor that I need to see an ENT to check on my ear. I have been taking Meclizine, but it hasn't helped.

Dr. Hibberd's Answer:

Imbalance can come from a wide range of disorders, and there is no “one fits all” approach. You should visit an ENT and ask what they feel you are suffering from, how long it is expected to last, and what further studies are recommended. Consider requesting a referral to a neurologist and cardiologist for second opinions. It might even be a good idea to go back to your primary care doctor and request a complete re-evaluation from scratch, especially if your ENT is uncertain. This is the way all referral diagnostic centers work, and there is no reason why you should not be entitled to a precise diagnosis supported by confirming studies.

While MRI is fine for some conditions, it is not always as sensitive as we wish, and there are times other studies (i.e. MRA and PET scanning) are indicated, especially when recommended treatment has failed to improve your imbalance. Never be afraid to ask for a second or alternate opinion. If your doctor balks at another opinion, it is time to seek out a different doctor.