Posted by: Thixia | June 21, 2008

Dizziness, Vertigo, and Imbalance Section 1 of 8

·       Introduction

·       History

·       Physical Examination

·       Vestibular Diagnostic Tests

·       Medical Treatment

·       Medication

·       Conclusion

·       Authors and Editors




Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches).  The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years.  The incidence of falling is 25% in subjects older than 65 years.  Falling can be a direct consequence of dizziness in this population, and the risk is compounded in those with other neurologic deficits. 

Mild hearing loss is the most common disability.  The incidence of hearing loss is 25% in people younger than 25 years, and it reaches 40% in persons older than 40 years.  About 25% of the population report tinnitus.  Tinnitus and hearing loss are commonly associated with inner-ear diseases, leading to vertigo and dizziness.

Migraine is more prevalent (10%) than Ménière disease (<1%).  About 40% of patients with migraine have vertigo, motion sickness, and mild hearing loss.  Therefore, differentiating migraine from primary inner-ear disorders is sometimes difficult.

The role of the primary care physician and the neurologist in treating patients with dizziness or verity has increased over the last decade.  This article outlines the clinical approach to the patient with dizziness from a neurologic perspective.  Emphasis is on differentiating peripheral from central dizziness and on office management of the most common diseases.  In addition, indications for referral to an otolaryngologist and/or neuro-otologist and for specialized vestibular testing are discussed.


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