Thank you so much for stopping by our new blog! This blog series is an excerpt from our Free Vestibular Rehab Mini Masterclass. You’re in the right place if you're looking to:
- Expand your knowledge in vestibular rehab
- Help more people with dizziness and balance problems
- Collaborate with other healthcare professionals in the vestibular space!
We will discuss the dizziness differential diagnosis algorithm to create a working diagnosis from the patient’s symptom of dizziness, which is considered a vague term. A more differential diagnosis can be narrowed with a thorough intake, review of medical history and review of systems combined with the physical examination. Unfortunately, imaging does not yield a high level of sensitivity to identifying the etiology of dizziness1.
Recent studies find a series of bedside tests are superior to brain imaging in a portion of patients with acute spontaneous dizziness (e.g., sudden with no prior illness and/or stressful event). This includes a series of tests referred to as Head-Impulse-Nystagmus-Test-of-Skew (HINTS). The presence of a negative head thrust test, but presence of direction changing nystagmus and vertical skew deviation predicted stroke with 100% sensitivity and 96% specificity in patients with acute vertigo and at least one vascular risk factor after excluding those with a history of recurrent vertigo. However, HINTS is not sufficient to detect AICA strokes2.
A comprehensive audiogram can play a critical role in the diagnosis even in the absence of reported hearing loss for both peripheral vestibular and central lesions. In addition, any patient presenting with an asymmetrical hearing loss needs a comprehensive audiogram immediately.
As for treatment of dizziness, customized vestibular rehabilitation shows >85% efficacy in peripheral vestibular disorders3 yet meclizine is prescribed as high as 89% of the time but results in <50% improvement4. The median time between the initial visit and receiving a vestibular disorder diagnosis is one month when the physician initially suggested the dizziness might be inner ear related versus eight months when not considered5.
Customized vestibular rehabilitation and identifying the cause(s) of dizziness can be complex and time consuming. Our education serves to help you through the process. You will learn how to utilize clues from the history to create a working/differential diagnosis, recognize appropriate vestibular diagnostics to further support the diagnosis, describe types of vestibular related disorders and much more...let’s get started!
Click here to progress to the next blog in this series: Characteristics of Dizziness
References: (1) Post RE and Dickerson LM. Am Fam Physician, 2010. (2) Kattah JC et al. Stroke, 2009. (3) Horak et al. J Otolaryngol Head Neck Surg, 1992. (4) Kroenke. Arch Int Med, 1990. (5) Haven L. VEDA On the Level, 2011.