Diagnosis and Treatment of Dizziness

Diagnosis

1. Vertigo

(1) Peripheral vestibular disorders

The characteristics of peripheral vestibular disorders are symptoms such as hearing loss (decreased hearing) in one ear, ringing in the ears (tinnitus), and a feeling of fullness in the ear. Nystagmus-provoking tests are helpful in diagnosing peripheral vestibular disorders. Nystagmus is a phenomenon in which, when the eye position slowly shifts to one side, the brain repeatedly moves the eyes quickly back to their original position. The presence or absence of nystagmus, its direction, speed, and nystagmus seen during straight-ahead gaze provide important information in identifying the cause of dizziness. In benign paroxysmal positional vertigo, dizziness is related to changes in posture, so it is evaluated with a positional nystagmus test that observes eye movements when the head position changes. In vestibular neuritis, the site of the lesion can be identified with the head impulse test, and the diagnosis can be made by checking for semicircular canal paralysis with caloric testing of both ears. In Meniere’s disease, diagnosis can be made by checking for accompanying auditory symptoms such as decreased hearing and tinnitus, and by performing hearing tests to confirm changes in hearing thresholds.

(2) Central vestibular disorders

Characteristic nystagmus of central vestibular disorders, diplopia in which objects appear doubled, and gait ataxia (a neurological abnormality causing incoordination of movements of the head, trunk, and legs) suggest lesions in the cerebellum or brainstem. The diagnosis of central dizziness can be made mainly using a detailed medical history, brain computed tomography (CT), brain magnetic resonance imaging (MRI), and hearing tests.

2. Syncope-related dizziness

Syncope that occurs while standing still for a long time, repetitive rapid breathing such as blowing up balloons (hyperventilation), during blood tests at the hospital, while lifting heavy objects, during urination or defecation, with emotional stress, in crowded narrow spaces, excitement, drinking alcohol, pain, or when wearing tight clothing around the neck can be diagnosed through a history of the situation and accounts from people around the patient. Syncope caused by the heart can occur due to arrhythmia or problems related to cardiac function. In such cases, tests such as electrocardiography and echocardiography, as well as consultation with a cardiology specialist, are necessary. Since syncope can rarely occur in hypoglycemia as well, blood glucose testing is also needed. It can also appear in anxiety, panic disorder, depression, and somatic symptom disorder. In these cases, fainting occurs without warning symptoms, and repeated falls do not easily cause injury. Psychiatric evaluation is needed in such cases.

3. Dizziness due to balance disorder

This is dizziness that occurs when there is an abnormality in proprioceptive sensation, cerebellum, or other systems responsible for motor transmission and balance. First, it is important to review medication use and medical history, and neurological examination is needed for diagnosing balance disorders. Brain CT and brain MRI are needed to diagnose brain lesions.

Treatment

If dizziness occurs suddenly, the most important thing is to rest in a comfortable position.

Treatment according to the cause and medication treatment according to the symptoms can be provided.

1. Vertigo

1. Peripheral vestibular disorders

Benign paroxysmal positional vertigo, the most common cause of dizziness, may recover on its own, but for rapid symptom improvement, canalith repositioning can be performed to return the otoliths in the semicircular canal to their original position by changing body position. In cases where unilateral vestibular function is acutely lost, such as vestibular neuritis, vestibular suppressants may be used during the acute phase. Vestibular suppressants can relieve acute symptoms that appear suddenly and rapidly, but because they may interfere with recovery, they should be used for only a short time. If possible, normal activities should be resumed as soon as possible, and vestibular rehabilitation exercises are necessary for a quick return to daily life.

2. Central vestibular disorders

Treatment for acute dizziness is similar to that for peripheral vestibular disorders, but because some cases, such as cerebellar infarction or tumor-related disease, may require hospitalization or surgery, definitive treatment of the underlying disease is necessary after an accurate diagnosis.

2. Syncope-related dizziness

Preventive treatment is provided to prevent syncope from occurring. To maintain cerebral blood flow, raise the legs while lying down, and loosen clothing that is tight around the body or neck. Since orthostatic hypotension improves when lying down after symptoms occur, education such as standing up in stages when getting up from lying down is necessary, and in particular, patients should be instructed not to get up suddenly from bed. In cases caused by arrhythmia or cardiac function, treatment is provided in consultation with a specialist according to the cause. For syncope (dizziness) due to hyperventilation syndrome, breathing control can be managed as an exercise using a paper bag, and psychogenic dizziness may be helped by cognitive therapy and behavioral therapy, along with medication.

3. Dizziness due to balance disorder

The most important thing is to avoid medications that are toxic to the ear, and treatment is provided according to the cause. For cerebellar dysfunction and sensory nerve damage caused by alcohol intoxication, dizziness may improve somewhat with abstinence, vitamins, and nutritional therapy. For other causes such as peripheral neuropathy and Parkinson’s disease, treatment of the underlying disease is necessary.

So far, I have explained the diagnosis and treatment of dizziness.

In the next installment, we will learn about tenosynovitis, which is unfamiliar to many of us.

Source: Korea Disease Control and Prevention Agency National Health Information Portal