Dizziness & Vertigo Examination & Investigation

Physical/Signs

• Examination of ear drums (otoscopy for):

  • Vesicles (Ramsay Hunt syndrome)
  • Cholesteatoma

• Tuning fork tests for hearing loss – Rinne/Weber tests.

• Cranial nerve examination. Cranial nerves should be examined for signs of:

  • Nerve palsies
  • Sensorineural hearing loss
  • Nystagmus

Gait Tests

Romberg’s Sign:

• Note: Not particularly useful in the diagnosis of vertigo.

Dix-Hallpike Manoeuvre

• The most helpful test to perform on patients with vertigo.
• If rotational nystagmus occurs, then the test is considered positive for BPPV.
  • During a positive test, the fast phase of the rotary nystagmus is toward the affected ear, which is the ear closest to the ground.

Head Impulse Test / Head Thrust Test

• Useful in recognizing acute vestibulopathy.

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Investigations

Special Auditory Tests

• Audiometry helps establish the diagnosis of Meniere’s disease.
• The history is most important and may give a good indication of the cause of vertigo. General medical causes such as:
  • Anaemia
  • Hypotension
  • Hypoglycaemia
  These may present with dizziness and therefore should be investigated.

CNS Causes

• If features of CNS causes are suspected from the history or examination:
  • CT/MRI brain imaging as appropriate.