Otolaryngology Book

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VertigoAka: Vestibular Exam

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  1. Epidemiology
    1. Most common cause of Dizziness (54% of cases)
      1. Kroenke (1992) Ann Intern Med 117:898
  2. Pathophysiology
    1. Sensation of spatial disorientation
    2. Stimuli Mismatch: vestibular, visual, somatosensory
  3. Symptoms
    1. Vertigo pattern
      1. Sensation of movement (usually spinning)
        1. Room is spinning around patient
      2. Episodic (Discrete attacks)
        1. Onset: Sudden
        2. Duration: several hours
        3. May experience residual queasy feeling for days
      3. Provocative: Change in head position
      4. Palliative: Rest
    2. Associated Symptoms
      1. Nausea or Vomiting
      2. Hearing Loss
      3. Tinnitus
    3. Symptoms suggesting other cause Dizziness (not vertigo)
      1. Patient senses spinning on the inside
      2. Constant unremitting Dizziness
      3. No Nystagmus present
  4. Signs
    1. Vital Signs
      1. Orthostatic Blood Pressure and Pulse
    2. Complete Head and Neck Exam
      1. Nystagmus
      2. Provocative Testing
        1. Dix-Hallpike Maneuver
      3. Ear Exam
        1. Tuning Fork Tests
          1. Weber Test and Rinne Test
          2. See Hearing Loss
        2. Middle Ear Anatomy
          1. Tympanic Membrane Perforation or erythema
          2. Tympanic membrane vessicles: Herpes Zoster Oticus
          3. Cholesteatoma (Posterior superior aspect of TM)
    3. Neurologic Exam
      1. Cranial Nerves
      2. Cerebellar tests
        1. Rapid alternating movements
        2. Balance (Romberg and Gait)
      3. Carotid Bruits
      4. Do not perform Carotid Sinus Massage
  5. Labs
    1. See Vertigo Labs
  6. Diagnostics and Imaging
    1. See Vertigo Diagnostic Testing
  7. Differential Diagnosis: Dizziness
    1. Vertigo Causes
      1. Peripheral Causes of Vertigo
      2. Central Causes of Vertigo
      3. Miscellaneous Causes
        1. Motion Sickness
        2. Vertigo Caused by Medication
        3. Psychological cause
    2. Dysequilibrium
    3. Syncope
    4. Light Headedness
  8. Management
    1. See Vertigo Management
  9. References
    1. Baloh (1999) Postgrad Med 105(2):161
    2. Knox (1997) Am Fam Physician 55(4):1185
    3. Labuguen (2006) Am Fam Physician 73:244
    4. Tusa (2005) Neurol Clin 23:655
    5. Tusa (2003) Med Clin N Am 87:609

Vestibular Diseases (C0042594)

Definition (MSH)Pathological processes of the VESTIBULAR LABYRINTH which contains part of the balancing apparatus. Patients with vestibular diseases show instability and are at risk of frequent falls.
ConceptsDisease or Syndrome (T047)
MSHD015837
EnglishDISORDER VESTIBULAR, VESTIBULAR DIS, Vestibular Disease, Vestibular Diseases, Vestibular disorder, Vestibular disorders, VESTIBULAR PROBLEM, Vestibular syndromes/disorders
Spanishtrastorno vestibular
Parent ConceptsBrain Diseases (C0006111), Ear Diseases (C0013447), Diseases of inner ear (C0494559), Labyrinthine disorder (C0022890), Duplicate concept (C1274013)
SourcesCOSTAR, CST, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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