Diagnosis

“Most clinicians find it difficult to diagnose dizzy patients, as the potential causes span various subspecialties, including internal medicine, neurology, otology, ophthalmology and psychiatry”^[1]

“Dizziness, imbalance, faints and falls fit within a spectrum of presentations which overlap each other” ^[2]

Individuals experiencing dizziness and imbalance symptoms should consult their medical practitioner as soon as possible. Initially this will be your local General Practitioner or Medical Officer. Subsequently you may be referred to a Medical Specialist including Neurologists, ENT’s, Neuro-otologists, Vestibular Physiotherapists and Audiologists.

These Specialists may order a number of tests to help determine the underlying causes of your symptoms.

Treatments prescribed depends on the underlying causes. They may include medication, head repositioning manoeuvres, surgery as a last resort, Vestibular Rehabilitation Therapy, etc. Lifestyle and dietary changes can be helpful, especially low salt diets, reduction of stress etc. Some people report alternative therapies are of assistance.

Specific diagnosis, tests, treatments, and lifestyle changes for different types of Vestibular Disorders can be found on our pages dealing with particular vestibular disorders. Click here for more information.

If you believe you have a vertigo condition, we recommend you follow the strategies in our 6 Step Action Plan.

It is of great assistance to your doctor if you can give a description of your symptoms and an accurate record of when they occurred and how long they lasted. Keeping a patient time log of symptoms experienced is a good idea. A personal symptoms diary for individuals with chronic balance disorders is part of your Whirled Foundation membership.

Knowing the answers to three questions in particular will help your doctor in determining the next steps in your treatment.

1. Do you feel as if you’re spinning? True rotational vertigo indicates a disorder of the inner ear or its brain stem connections.
2. Do you feel as if you’re going to faint? Faintness suggests a cardiovascular cause.
3. Do you feel unsteady on your feet even though your head is clear? Disequilibrium of this sort is common in patients with neurological disorders affecting balance and coordination.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For dizziness, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms?

• What kinds of tests do I need?

• Is this problem likely temporary or long lasting?

• What treatment options might help?

• Should I see a specialist?

• Are there any brochures or other printed material that I can take home with me?

• What websites do you recommend visiting?

NEED MORE INFORMATION

Click here to read a presentation by Balance Specialist Dr Szmulewicz who describes the challenges in diagnosis and proposes a simpler path.

References

^[1] Bronstein A.M ” Dizziness: A practical approach to Diagnosis and Management”. Cambridge Clinical Series 2007.

^[2] Witana J. “All that glitters is not …. All that is dizzy is not ‘ear’!” British Society of Neuro-otology 2011.

Tests

Diagnosing a vestibular disorder is not always simple. There may be a number of tests you will need to undertake including:

• Blood tests
• CT Scan or MRI
• A full examination of hearing and balance

The following information is sourced from The Royal Victorian Eye and Ear Hospital.

When you visit the specialist you may undergo several assessments including:

• An eye movement assessment using video goggles
• An assessment of the coordination of your arms and legs
• A balance and walking assessment.

Further testing may include;

Hearing test – Assessment of hearing function is necessary to make an accurate diagnosis.

cVEMP – monitors neck muscle activity while the head is raised off a pillow and clicking noises are played through headphones.

oVEMP – monitors eye muscle activity while eyes are directed upwards and a tapper is placed on the forehead.

Calorics – Eye movements are recorded as cool or warm air or water is inserted into the inner ear.

Rotational Chair – A camera records eye movements whilst you are seated in a chair which rotates back and forth.

Video Head Impulse Test (vHIT) – eye movements are recorded whilst quick and small head movements are performed from side to side.

Expect some costs involved in the diagnosis process and it may take a few weeks before you get any answers. However, continue to persevere, as an accurate diagnosis is important so you and your medical team know exactly what you are dealing with and how best to move forward with treatment and management.