ear, nose, and throat disorders
Dizziness and Vertigo
Evaluation of Dizziness and Vertigo
The following information can help people with dizziness decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with dizziness, certain symptoms and characteristics are cause for concern. They include Headache Neck pain Difficulty walking Loss of consciousness (fainting) Other neurologic symptoms (such as trouble hearing, seeing, speaking, or swallowing or difficulty moving an arm or leg) People who have warning signs, those whose symptoms are severe or have been continuous for over an hour, and those with vomiting should go to a hospital right away. Other people should see their doctor as soon as possible. People who had a single, brief (less than 1 minute), mild episode with no other symptoms may choose to wait and see whether they have another episode. In people with dizziness, doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the dizziness and the tests that may need to be done (see table). In addition to warning signs, important features that doctors ask about include severity of the symptoms (has the person fallen or missed work), presence of vomiting and/or ringing in the ears, whether symptoms come and go or have been continuous, and possible triggers of the symptoms (for example, changing position of the head or taking a new drug). During the physical examination, the ear, eye, and neurologic examinations are particularly important. Hearing is tested, and the ears are examined for abnormalities of the ear canal and eardrum. The eyes are checked for abnormal movements, such as nystagmus. ( Ear Ringing or Buzzing ) suggests that people may have a disorder of the inner ear. suggests a disorder affecting the inner ear or various nerve connections in the brain stem. With nystagmus, the eyes rapidly and repeatedly jerk in one direction and then return more slowly to their original position. Doctors deliberately try to trigger nystagmus if people do not have it spontaneously because the direction in which the eyes move and how long the nystagmus lasts help doctors diagnose the cause of vertigo. To trigger nystagmus, doctors first lay people on their back and gently roll them from side to side while watching their eyes. Specialists sometimes have the person wear thick, one-way, magnifying glasses called Frenzel lenses. Doctors can easily see the person's magnified eyes through the lenses, but the person sees a blur and cannot visually fixate on anything (visual fixation makes it harder to trigger nystagmus). During the maneuver to induce nystagmus, eye movements may be recorded by using electrodes (sensors that stick to the skin) placed around each eye (electronystagmography) or by a video camera attached to the Frenzel lenses (video electronystagmography). If no nystagmus occurs with rolling side to side, doctors try other maneuvers. These other maneuvers include putting ice-cold water into the ear canal (caloric testing) and rapidly changing the position of the person's head ( Benign Paroxysmal Positional Vertigo ). Doctors also do a complete neurologic examination, paying particular attention to tests of walking, balance, and coordination. The need for tests in people with dizziness or vertigo depends on what doctors find during the history and physical examination, particularly whether warning signs are present. For people with a sudden attack of dizziness that is still going on, doctors usually apply a fingertip oxygen sensor, measure blood glucose from a drop of blood from the fingertip. Some women get a pregnancy test. People with warning signs typically require gadolinium-enhanced magnetic resonance imaging (MRI), as do people without warning signs who have had symptoms for a long time. Several tests can be used to evaluate balance and gait, such as the Coordination, Balance, and Gait . Another test of balance has the person walking a straight line with one foot behind the other. If the doctor's examination shows possible hearing loss, people are usually sent for a formal hearing test ( Comprehensive vestibular testing is sometimes done. This testing includes video electronystagmography (computerized recording and analysis of abnormal eye movements), rotary chair testing (looking for abnormal eye movements while sitting in a chair that is rotated), and vestibular-evoked myogenic potential testing. These tests are typically done by doctors who specialize in the care of the ear (otolaryngologists). Electrocardiography (ECG), Holter monitoring for heart rhythm abnormalities, echocardiography, and exercise stress testing may be done to evaluate heart function. For Testing , specific tests may be needed. 