Dizziness Depot

 “Why are you doing a hearing test? My hearing is just fine.” I’ve heard this frequently enough over the years that I know to take a minute to explain to every vestibular patient, before we get started, why we require an audiogram. I keep it pretty straightforward and simple: “We do a quick hearing test on every patient complaining of

  This post falls in the Op-Ed category. It is simply the opinion of the editor (That’s me). Feel free to disagree. I don’t mind. In the series of vestibular codes, there is CPT Code 92548 – Computerized Dynamic Posturography. In the AMA code descriptor there is no detailed description of how this procedure is performed, or what equipment is

 MOTT (MOST OF THE TIME) LIST            (General rules to aid in the dizziness diagnosis)  A complaint of Vertigo MOTT indicates a peripheral vestibular asymmetry, but can mean Migraine or Infarct A complaint of Lightheadedness, Faintness MOTT is not vestibular. Vertigo, of less than 1 minute duration when lying down or tilting head MOTT indicates BPPV.

      Once you feel that you have a solid grasp on the timing, triggers and quality of the “Dizzy” complaint, you should inquire about other symptoms associated with vestibular disease and health conditions that may lead to pre-syncope or dysequlibrium. Associated Symptoms Symptoms such as tinnitus, hearing loss, otalgia, or aural fullness, particularly unilateral complaints, suggest the probability

Precipitating, Exacerbating, or Relieving Factors (Triggers) Symptoms that are brought on or increased by a change in head position, or with eyes closed, suggest peripheral disease. Symptoms noticed only while standing, but never when sitting or lying, suggest vascular or orthopedic disease. Symptoms that are constant and are unaffected by position change are suggestive of central or psychiatric pathology. To

Temporal Course (Timing)   Temporal course includes information regarding the onset, duration, and frequency of symptoms. In general, dizziness lasting for less than 1 minute when the patient is lying down is associated with benign paroxysmal positional vertigo (BPPV), whereas dizziness lasting less than 1 minute when the patient stands up is associated with orthostatic hypotension (OH). Note: Dizziness from

Quality of Vestibular Symptoms Traditional medical education stresses that most complaints of dizziness fall within one of four broad categories: Vertigo(described as a sensation or illusion of spinning or rotation which is traditionally associated with peripheral vestibular etiology, )Presyncope (technically describes a sensation of imminent loss of consciousness, but it is frequently used to categorize the sensation of lightheadedness), Dysequilibrium

Structure of the Case History Interview   The case history interview should be initially unstructured and open ended. Patients should be allowed to tell their story with minimal interruption. One approach is to ask the patient, “Tell me, what brings you here?” It is helpful to ask patients to start at the beginning and present their story chronologically. Patients should

Role of the Case History Interview   A thorough history is critical for three main reasons: 1. Many patients have difficulty articulating their symptoms beyond simply describing themselves as being “dizzy.” 2. Additional evaluation and treatment will differ depending on the suspected site of the lesion. Patients with BPPV may not require caloric testing to achieve diagnosis and successful treatment.

“Good morning Mrs. Butterworth, Tell me what you brings you here today?” Mrs. Butterworth: “I’m dizzy.” What have I learned? Nothing. The term “dizziness” serves as a catch-all phrase for a wide range of sensations, making it an inadequate descriptor. It encompasses experiences such as vertigo, lightheadedness, faintness, disorientation, and gait instability. These diverse complaints can arise from various underlying