From the Guidelines
Laboratory workup for peripheral vertigo should include audiometry, vestibular function tests, and basic blood tests, such as complete blood count, electrolytes, glucose, and thyroid function tests, as recommended by the most recent guidelines 1. The initial evaluation of peripheral vertigo typically involves a combination of clinical history, physical examination, and laboratory tests to rule out underlying metabolic or vestibular causes.
- The clinical history should include a review of the patient's symptoms, medical history, and medication list, as outlined in the 2017 clinical practice guideline for benign paroxysmal positional vertigo 1.
- Physical examination should include Dix-Hallpike (positional) testing, supine roll test, and bow and lean test side-lying maneuver to assess for benign paroxysmal positional vertigo (BPPV) 1.
- Laboratory tests should include:
- Audiometry to identify hearing loss that may accompany conditions like Meniere's disease
- Vestibular function tests, such as electronystagmography (ENG) or videonystagmography (VNG), to assess eye movements and vestibular function
- Rotational chair testing to evaluate vestibulo-ocular reflexes
- Vestibular evoked myogenic potentials (VEMP) to assess otolith function
- Caloric testing to diagnose vestibular hypofunction
- Basic blood tests, such as complete blood count, electrolytes, glucose, and thyroid function tests, should be performed to rule out metabolic causes, as recommended by the 2024 ACR Appropriateness Criteria for dizziness and ataxia 1. It is essential to note that imaging studies like MRI may be necessary to rule out structural abnormalities, though these are more commonly used for central vertigo, and should be guided by the results of the HINTS examination and other clinical factors 1. The pattern of abnormalities across these tests helps pinpoint the specific peripheral vestibular disorder, allowing for targeted treatment approaches rather than symptomatic management alone.
From the Research
Laboratory Tests for Peripheral Vertigo Workup
The following laboratory tests and assessments are used to diagnose peripheral vertigo:
- Audiological testing to evaluate hearing and balance function 2
- Neuroimaging, such as MRI or CT scans, to rule out central causes of vertigo 2, 3
- Dix-Hallpike maneuver and supine roll test to diagnose benign paroxysmal positional vertigo (BPPV) 4, 5, 6
- Head impulse test to assess vestibular function 3
- Test of skew to evaluate vestibular-ocular reflex 3
- Direction-changing gaze-evoked nystagmus test to assess vestibular function 3
Specific Tests for Benign Paroxysmal Positional Vertigo (BPPV)
- Canalith repositioning procedure to treat BPPV 5, 6
- Particle repositioning maneuver to treat posterior canal BPPV 6
- Supine roll test to diagnose horizontal canal BPPV 6
Importance of Accurate Diagnosis
Accurate diagnosis of peripheral vertigo is crucial to rule out central causes, such as stroke or transient ischemic attack, and to guide appropriate treatment 2, 3, 4