Dizziness is a nondescript symptom meaning something different to each individual. The term is commonly used by patients to characterise sensations including vertigo, imbalance, presyncope, and light-headedness. Over one third of Australians over the age of 50 experience some dizziness or vertigo.
The differential diagnosis of dizziness is complex. One third of patients are still symptomatic after a five-year period and only one in four ever receive treatment for their dizziness. Even for benign paroxysmal positional vertigo, studies show the average time from symptom onset to diagnosis can be 19 to 70 months.
Undiagnosed and untreated dizziness can significantly impact quality of life. The psychological impacts include increased social isolation, anxiety, and depression. Dizziness can lead to lost work time and reduced productivity. In the elderly, it is associated with reduced physical activity and an increased falls risk.
For the majority of patients, a thorough history will make the diagnosis and inform treatment. This history would include temporal features, associated auditory or wider symptoms, and any specific triggers.
A formal assessment of the vestibular system with an audiologist can offer supplementary information to facilitate diagnosis and management. Test results include objective, side-specific, and receptor-specific information.
Videonystagmography (VNG) utilises an infrared video system attached to goggles to monitor and record eye movements. The VNG battery includes a series of subtests evaluating different components of the peripheral and central vestibular system, including preliminary tests for central lesions.
Electrophysiological testing is performed to assess auditory evoked potentials, including vestibular evoked myogenic potentials (VEMP). VEMP testing assesses the function of the otolith organs and is a valuable diagnostic tool in the diagnosis of semicircular canal dehiscence.
Caloric irrigation remains the gold standard for diagnosing peripheral a vestibular lesion, doing so through assessing the vestibulo-ocular reflex. Caloric testing’s pitfall is that it only measures the horizontal semicircular canals. Video head impulse testing (vHIT) complements caloric testing and can assess function of all six canals, helping to better localise peripheral lesions.
Vestibular rehabilitation therapy (VRT) is the foundation of treating many causes of dizziness. The vestibular pathway demonstrates a high degree of neural plasticity and the aim of VRT is to facilitate central compensation.
Successful VRT results in improved gaze stability, reduced dizziness, improved postural stability and gait, and helps patients restore normal function and activity. VRT has been demonstrated to show both subjective and objective improvements in a patient’s symptoms
The author wishes to acknowledge the input of Ellen Putland in the writing of this update.
- Dizziness is common
- Accurate assessment is needed to inform treatment
- Vestibular rehabilitation can improve symptoms
References available on request.
Questions? Contact the editor.
Author competing interests: None to disclose.
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