Dizziness

Diagnosis  

Physical examination: During the physical examination, your doctor will evaluate various aspects of your nervous system, balance, and sensory functions. Additional assessments may include: 

• Walking and balance assessment: Your doctor will observe your walking and balance abilities. 
• Nerve function examination: They will check the functioning of major nerves within your central nervous system. 
• Hearing test: You may undergo a hearing test. 
• Balance tests: These tests assess your balance and may include: 
  • Eye movement testing: Tracking your eye movements while following a moving object and conducting eye motion tests involving the ear canal. 
  • Head movement testing: For suspected benign paroxysmal positional vertigo, your doctor may perform the Dix–Hallpike maneuver. 
  • Posturography: To identify balance system strengths and weaknesses, you’ll stand barefoot on a platform under various conditions. 
  • Rotary chair testing: Sitting in a computer–controlled chair that moves slowly in a full circle or back and forth at different speeds. 

Imaging: If your doctor suspects a potential stroke, particularly if you are older or have a history of head injury, they will likely order two essential diagnostic tests: 

• • Magnetic Resonance Imaging (MRI) 
  • Computed Tomography (CT) Scan 

Blood test: Blood tests to check for infections and other exams to assess the patient’s heart and blood vessel health may also be performed.  

Treatment  

Dizziness often improves on its own within a few weeks as the body naturally adapts to its underlying cause. However, seeking treatment from a doctor depends on the cause and symptoms. Treatment options may involve medications and balance exercises personalized to your specific condition. Even if the cause remains unidentified or if dizziness persists, prescription drugs and other therapeutic approaches can be used to enhance symptom management. 

Medications 

• Diuretics (Water pills): If you’re diagnosed with Meniere’s disease, your physician might prescribe diuretics, commonly known as water pills. When combined with a low–sodium diet, these medications can potentially reduce the frequency of dizziness episodes. 
• Medications for immediate relief: To alleviate symptoms of vertigo, dizziness, and nausea, your doctor may recommend prescription antihistamines and anticholinergics. Many of these drugs have the side effect of causing drowsiness. 
• Anti–anxiety medications: Drugs such as Diazepam and alprazolam, which belong to the benzodiazepine class, might be prescribed for anxiety associated with Meniere’s disease. It’s important to note that these medications can be habit–forming and may also induce drowsiness. 
• Migraine prevention medication: Some specific medications can be effective in preventing migraine attacks. Your healthcare provider may suggest these as part of your treatment plan. 

Therapy 

• Head position maneuvers: A technique known as the canalith repositioning maneuver, or Epley maneuver, can often expedite the resolution of benign paroxysmal positional vertigo instead of waiting for dizziness to naturally subside. This procedure can be administered by a medical professional, audiologist, or physical therapist, involving the careful adjustment of head positioning. Typically, significant improvement is observed after one or two sessions. It’s important to inform your healthcare provider if you have any neck or back conditions, a detached retina, or blood vessel problems before undergoing this procedure. 
• Balance therapy: Vestibular rehabilitation, a form of physical therapy, can provide targeted exercises to reduce the sensitivity of your balance system to motion. This approach is particularly beneficial for individuals experiencing dizziness due to inner ear conditions such as vestibular neuritis. 
• Psychotherapy: For individuals whose dizziness is attributed to anxiety disorders, psychotherapy offers a potential solution. This form of therapy can help address the underlying psychological factors contributing to the dizziness. 

Other procedures 

• Injections: Gentamicin injections can be administered to the inner ear to disrupt its balance function, with the unaffected ear compensating.
• Inner ear sense organ removal: In rare cases, a labyrinthectomy procedure may be considered, disabling the affected ear’s vestibular labyrinth and transferring balance function to the other ear. This option is typically reserved for severe cases with hearing loss unresponsive to other treatments.