Referring Physicians >>
September 2011 Otologic, Head & Neck Newsletter >>
Evaluation for Dizziness and Vertigo
Dizziness and imbalance are two of the most common complaints for patients visiting their primary care physicians. Multiple disciplines, including Otolaryngology, play a role in the management of these patients.
Otolaryngologists are primarily involved in the diagnosis and management of patients with acute rotational vertigo. The most common causes include:
A thorough history is important to develop a differential diagnosis and establish whether the patient may have a central or peripheral cause for their symptoms. Important factors to consider include:
Patients with recurrent vertigo, which is a rotary movement of the external environment, should be evaluated by Otolaryngology if symptoms persist.
The Otolaryngology work-up for rotational vertigo is extensive and includes a history, questionnaire, and comprehensive vestibular physical examination. After a working diagnosis is established, diagnostic testing is performed which may include the following:
Tests are selected in a cost-effective manner based on the initial history and physical examination.
Patients with dizziness may present with a variety of symptoms. Appropriate history will guide the primary care physician as to the best referral option.
An Otolaryngologist should see:
Neurology should see:
A Rehabilitation Therapist should see:
Treatment may include medical therapy, surgical therapy, or specific physical therapy. Many patients who are disabled by chronic episodic vertigo can be managed with surgical intervention. For patients specifically with Meniere’s disease, office procedures including minimally invasive intratympanic therapy are an option to other forms of surgery. Consultation with an Otolaryngologist or Otologist will help to determine the course of therapy with the least risk and morbidity.