From the Guidelines
The diagnosis and management of dizziness relies on several key clinical tests, with the Dix-Hallpike maneuver being essential for diagnosing benign paroxysmal positional vertigo (BPPV) 1. The Dix-Hallpike maneuver is performed by rapidly moving the patient's head from sitting to lying with the head turned and hanging slightly off the examination table to observe for nystagmus. Other important tests include:
- The head impulse test to identify vestibular hypofunction by having the clinician quickly turn the patient's head while they focus on a target; if their eyes cannot remain fixed, it suggests peripheral vestibular dysfunction.
- Romberg's test to evaluate balance by having patients stand with feet together and eyes closed.
- The Fukuda stepping test to detect vestibular imbalance as patients march in place with eyes closed.
- Electronystagmography (ENG) and videonystagmography (VNG) to objectively record eye movements during various positional changes.
- Caloric testing to assess vestibular function by irrigating the ear canal with warm or cold water to stimulate the vestibular system.
- Audiometry to identify hearing loss associated with certain vestibular disorders.
- Posturography to measure a patient's ability to maintain balance under various sensory conditions. These tests help differentiate between peripheral causes (like BPPV or vestibular neuritis) and central causes (like stroke or multiple sclerosis), guiding appropriate treatment strategies for dizziness 1. The most recent and highest quality study 1 recommends the use of these clinical tests to diagnose and manage dizziness, prioritizing the Dix-Hallpike maneuver for BPPV diagnosis. It is also important to note that patient education and counseling are crucial in the management of BPPV, including discussing the risk of falls, recurrence, and the importance of follow-up 1. Overall, a comprehensive approach to diagnosing and managing dizziness involves the use of these key clinical tests, as well as patient education and counseling.
From the Research
Clinical Tests for Dizziness
The diagnosis and management of dizziness involve a combination of clinical tests and evaluations. Some of the key tests used include:
- Orthostatic blood pressure measurement to assess for any significant changes in blood pressure that could be contributing to dizziness 2, 3
- A full cardiac and neurologic examination to identify any underlying conditions that may be causing dizziness 2, 3
- Assessment for nystagmus, which can be a sign of vestibular or central nervous system disorders 2, 3
- The Dix-Hallpike maneuver, which is used to diagnose benign paroxysmal positional vertigo (BPPV) 2, 3
- The HINTS (head-impulse, nystagmus, test of skew) examination, which can help distinguish between peripheral and central etiologies of dizziness 2, 3
Laboratory Testing and Imaging
Laboratory testing and imaging are not always required in the evaluation of dizziness, but may be helpful in certain cases. For example:
- Hearing assessment may be necessary to evaluate for hearing loss or other auditory symptoms that could be contributing to dizziness 4
- Further testing, such as MRI or CT scans, may be necessary to rule out central nervous system disorders or other underlying conditions 3, 4
Treatment Options
Treatment for dizziness depends on the underlying cause, but may include:
- Canalith repositioning procedures, such as the Epley maneuver, for BPPV 2, 3
- Vestibular rehabilitation, which can be helpful in treating many peripheral and central etiologies of dizziness 3, 4
- Pharmacologic intervention, which may be limited due to its potential to affect the central nervous system's ability to compensate for dizziness 3
- Surgical intervention, which may be necessary in some cases, such as for certain types of vestibular disorders 4