Dizziness Diagnosis: Clinics and Information

Vertigo can have numerous causes. Often, it is not a standalone condition but rather a symptom of another underlying disease. Vertigo diagnostics involve various methods to identify the causes of vertigo symptoms.

In the first step, the ENT specialist conducts a detailed medical history interview. As the patient, you report any previous medical conditions and describe precisely when the dizziness occurs and exactly how it feels. Be sure to also list any accompanying symptoms, such as nausea, vomiting, or visual disturbances. In most cases, the patient’s description alone is sufficient to establish an initial suspected diagnosis.

Depending on the suspected diagnosis, the doctor will order further tests. These include, for example,

• vestibular tests (examination of the balance organ in the inner ear),
• hearing tests, and
• orientational balance tests.

If the doctor suspects an underlying neurological cause, they will also order imaging tests (MRI or CT).

Temporary feelings of dizziness, such as after riding a roller coaster or standing up too quickly, are usually not a cause for concern. However, a medical evaluation using dizziness diagnostics is recommended if

• the dizziness occurs regularly over a prolonged period and
• other symptoms are present as well.

The appropriate first point of contact is an otolaryngologist (ear, nose, and throat specialist) or a specialist in vertigo medicine.

They distinguish between two types of dizziness:

• peripheral vertigo
• central vertigo

In peripheral vertigo, the cause of the symptoms lies in the vestibular nerve or the vestibular system. Central vertigo, on the other hand, is triggered by disorders in the brain, such as those caused by circulatory problems.

With the help of vertigo diagnostics performed by an ENT specialist, the following conditions can be diagnosed:

• Meniere’s disease (episodic attacks of rotational vertigo caused by damage to the vestibular nerve, often accompanied by hearing loss)
• Disorders of the vestibular system (failure or inflammation of the vestibular organ)
• Benign paroxysmal positional vertigo (caused by the detachment of calcium crystals)

We have already mentioned the most important methods of vertigo diagnosis in the introduction; now let’s examine them in detail.

Orientation Balance Tests

Orientation balance tests do not require any technical equipment. The patient must perform various exercises that allow for an assessment of their sense of balance:

• In the pointing test, the patient closes their eyes and extends both arms horizontally. They must then try to bring their index finger to the tip of their nose and touch it.
• In the Romberg test, the patient stands on both legs for 30 seconds with eyes open and 30 seconds with eyes closed. If the patient shows a tendency to sway or fall during this test, this indicates an impairment of the sense of balance.
• In the Unterberger walking test, the patient marches in place with their eyes closed for at least one minute. Deviations of more than 45° over 50 steps are considered abnormal.

Vestibular Tests

One of the most important diagnostic criteria for a disturbance of the sense of balance is nystagmus, which refers to uncontrolled eye movements.

Vision plays a significant role in maintaining balance. When the vestibular nerve and/or organ is damaged, the body attempts to restore spatial orientation with the help of the eyes. This manifests as twitching.

Caloric Irrigation

The caloric test allows for a side-by-side examination of the peripheral vestibular system.

The patient wears video goggles that record eye movements. The ear canals are then flushed one at a time with cold and warm water. The change in temperature sets the fluid in the semicircular canals of the ear in motion, which in turn triggers nystagmus toward the affected side.

Vertigo diagnostics determine whether the vertigo is caused by a disorder of the vestibular system © Henrie | AdobeStock

Video Head Impulse Test

The video head impulse test is one of the most advanced diagnostic procedures. As with the caloric irrigation test, it involves a side-specific assessment of the ocular response (nystagmus). In addition, the head impulse test allows for an evaluation of all six semicircular canals in less than ten minutes.

The patient wears video goggles that use ICS impulses. These mimic head movements from everyday life. The results are digitally recorded and monitored by the doctor on a computer.

Ocular and Cervical VEMP

The abbreviation VEMP stands for Vestibularly Evoked Myogenic Potentials. When the vestibular organs are stimulated by sound or movement, various muscle groups respond.

In this way, for example, involvement of the saccule (Latin: sacculus) in Meniere’s disease can be detected. The saccule, located in the inner ear, is an important component of the static system. If its function is impaired, it leads to episodes of vertigo.

In practice, the VEMP technique primarily involves air-conduction stimulation as well as bone-conduction stimuli. The patient wears electrodes and, if necessary, vertigo goggles to record the muscle responses. The physician monitors the results using a special display.

The cVEMP and oVEMP findings are also useful for diagnosing nerve inflammation in the inner ear. The extent of the inflammatory process can also be reliably assessed. In addition, the diagnostic procedure provides information on whether the lower or upper portion of the vestibular nerves is affected by damage.

Spinning Chair Test

Video goggles are also used in the swivel chair test. As the name suggests, the patient sits in a swivel chair and is rotated half a minute to the left and half a minute to the right. The video goggles record the eye movements.

Hallpike Test

This test is performed to diagnose benign positional vertigo. During the test, the doctor rapidly moves the patient’s head and torso in a specific sequence. Wearing video goggles is recommended to observe the eye movements.

Modern vertigo diagnostics can reliably identify the causes of peripheral and central vertigo. If the condition is a form of central vertigo, the patient is referred to a neurologist.

Modern diagnostic procedures pose no health risks. However, the examination itself may cause a temporary worsening of vertigo symptoms. This is usually desirable, though, to confirm the diagnosis.

For some patients, however, vertigo diagnostics yield no results. In this case, a psychosomatic cause (psychogenic vertigo) cannot be ruled out. It is important to note, however, that those affected are not imagining their symptoms. The dizziness is real, but the cause is not physical in nature. In this case, psychotherapy can help.

The prognosis for dizziness depends largely on the underlying condition.

• prompt medical treatment,
• medication if necessary, and
• targeted balance training

, many patients achieve complete relief from their symptoms.

If the doctor has diagnosed a disorder of the vestibular nerve or organ, it is particularly important to rest the body. Sometimes a hospital stay of several days is even necessary to administer intravenous medication (e.g., cortisone).

Once the acute symptoms have subsided, the patient begins specialized physical therapy to train their sense of balance.

Modern vertigo diagnostics include numerous methods for pinpointing the exact cause of the symptoms. A confirmed diagnosis, in turn, is the prerequisite for effective treatment.

Do not ignore your dizziness symptoms. The sooner a medical evaluation is conducted and appropriate treatment is initiated, the better the prognosis.