What do you mean when you say Dizzy? – Part II

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.

3. Some vestibular disorders cannot be differentiated solely on the results of vestibular evaluation. For example, an initial episode of Meniere’s disease may show very similar test results to labyrinthitis.

The value of a thorough history should not be underestimated. This is reflected in the result of one study in which a provisional diagnosis based only on case history and screening examinations proved correct for 76% of patients seen {{1}}[[1]]Kroenke, K., Lucas, C., Rosenberg, M., Sherokman, B., Herbers, J., Wehrle, P., et al. (1992). Causes of persistent dizziness: a prospective study of 100 patients in ambulatory care. Ann Intern Med, 117(11), 898–905.[[1]]

Pre-Examination Preparations

When possible, it is important that the patient be sent a questionnaire before the initial patient appointment with instructions to complete it before arriving for the appointment.* The questionnaire is not intended to be a substitute for a comprehensive case history interview but rather as a motivation for the patient to think about how to articulate the symptoms.

*This may be impractical in a patients presenting on an emergent basis with sudden onset acute vertigo.

The questionnaire should focus not only on current symptoms, but also on the patient’s recollection of previous episodes of dizziness. It should also include questions about associated symptoms that the patient may not consider part of the “dizziness problem”    Next week, we will cover the structure of the case history interview.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.