Dizziness

Robert T. Sataloff, M.D., D.M.A.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Mary J. Hawkshaw, R.N., B.S.N., C.O.R.L.N.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Robert Sataloff, M.D., is Professor of otolaryngology, head and neck Surgery – Thomas Jefferson University, Philadelphia, PA; adjunct professor of otolaryngology, Head and Neck Surgery – University of Pennsylvania School of Medicine, Philadelphia, PA.

The authors describe dizziness as a common and vexing problem, but not a hopeless one even though thorough testing of balance is hard to achieve. Five to ten percent of physician visits overall, and the majority of visits by patients over 65, are for complaints of dizziness or imbalance.

They point out that any patient with an equilibrium complaint needs a thorough examination and careful evaluation. They provide a list of 47 questions that are specifically designed to identify the problem underlying the patient's symptoms.

Vertigo, a mostly episodic condition, may result from a number of conditions which include acoustic neuroma, labyrinthine dysfunction and Meniere's syndrome. The authors describe the recognition and treatment of Benign Positional Paroxysmal Vertigo, and note that some causes of vertigo, such as Perilymph fistula are particularly amenable to surgical treatment.

Common central nervous system causes of vertigo that call for urgent attention are described. The authors also describe types of vascular crisis such as Wallenberg's syndrome and Horner's syndrome that can produce "sudden overwhelming vertigo."

Vertigo may also be associated with multiple sclerosis, epilepsy, and migraine ... and a standing rule in otology is that acoustic neuroma must be ruled out in patients with vertigo. MRI scanning is especially useful in detecting acoustic neuroma and other cerebella pontine angle tumors.

The pharmacologic treatment of vertigo which includes drugs such as Meclizine and which is often effective is reviewed in depth.

The lecture provides details with illustration of the causes of nystagmus and how the commonly used electronystagmography test for nystagmus, which records eye movements in order to document the presence and direction of nystagmus, plays a valuable role in determining the final diagnosis.

The authors conclude with the special considerations of dizziness, especially vertigo, in the workplace.

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