Expert Tips for Diagnosing Symptoms of Dizziness
Jennifer Derebery, MD Associate at House Ear Clinic, Inc Clinical Professor, Department of Otolaryngology at the University of Southern California School of Medicine
Though dizziness symptoms are common, I consider diagnosing the cause challenging due to the complexity of their possible origins. When diagnosing dizziness, I like to use the “three-legged stool” approach that places the brain as the master center of balance or the seat of the stool; with the three legs supporting the seat refer to the dizziness’ origin. The three legs are as labeled:
Vestibular System – The sensory mechanism in the inner ear that detects movement of the head and helps to control balance
Proprioceptive System – The sensory receptors that are found in the skin, muscles and joints that are sensitive to stretch or pressure in the surrounding tissues
Visual System – The sensory receptors in the retina when affected send impulses to the brain that provide visual cues identifying how a person is relative to the other objects they are looking at
Using the “Three-Legged Stool” approach to pinpoint the high level sources of the dizziness, you can begin to refine your original diagnosis. I also, outlined three types of differential diagnosis:
Peripheral – Inner Ear
Central – The Brain
Systemic – Leading to a symptom
After going through the basics, make sure to incorporate the patient in the diagnosis. It is essential to make the patient feel like they are contributing to their own diagnosis, so make it a point to ask the patient two important questions when diagnosing dizziness:
What the patient means by dizziness
Does the patient feel they are “spinning,” as with vertigo?
Do they feel “drunk” or imbalanced?
Timing of dizziness- Depending on the time frame, diagnosing the cause of dizziness can vary
Seconds of dizzy sensations could indicate benign positional vertigo
Minutes of dizziness could indicate a circulatory problem
Hours of dizziness could indicate Meniere’s or migraine
Days of dizziness could indicate viral labyrinthitis, and probably excludes the possibility of an inner ear problem
Constant dizziness probably does not indicate a primarily otolaryngological disorder
Whether the patient is experiencing hearing loss problems in one half of the inner ear can often affect the other
The pattern of the hearing loss can also offer clues to inner ear problems
Presence of hearing loss symptoms, plus the timing of the dizziness, are two strong indicators in the source of dizziness
The severity of the diagnosis can be quickly made through a proper imaging study and physical examination. Determining whether it is a hemorrhage or a central nervous system problem can be accomplished with a simple exam or imaging study.
Recurring symptoms of benign positional vertigo can often indicate migraine. Keys indications are headaches or other forms of head discomfort, but also can include motion-induced dizziness such as spinning or imbalanced sensations, even if they haven’t experienced these symptoms in several years. Ask the patient whether they are bothered by light or loud sound: these symptoms would also indicate possible migraine. For treatment options, watch Diagnosing Dizziness: Tips for the Primary Care Doctor.
For more information on diagnosing dizziness, please check out the video below or watch the whole webinar here.