How is vertigo diagnosed?

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Diagnosing vertigo involves a comprehensive evaluation that includes a detailed medical history, physical examination, and often a series of specialized tests to determine the underlying cause. Here’s an overview of the diagnostic process:

1. Medical History

Symptom Description: Your healthcare provider will ask you to describe your symptoms in detail, including the sensation of spinning, when it occurs, how long it lasts, and what triggers or relieves it. They will also inquire about associated symptoms, such as nausea, hearing loss, tinnitus, headaches, or vision changes.
Past Medical History: A review of your past medical history, including any history of ear infections, head injuries, migraines, or neurological conditions, is essential. The provider will also ask about any medications you are taking, as some can cause or contribute to vertigo.
Family History: A family history of conditions like Ménière’s disease or migraines may be relevant in diagnosing vertigo.

2. Physical Examination

Head and Neck Exam: The healthcare provider will examine your head and neck to assess for signs of injury, stiffness, or abnormalities in movement.
Ear Examination: The provider will check your ears for signs of infection, inflammation, or other abnormalities that could contribute to vertigo, such as fluid behind the eardrum.
Eye Movement Tests (Nystagmus): The provider will observe your eye movements, particularly looking for nystagmus (rapid, involuntary eye movements), which is a common sign of vertigo. Tests may include following an object with your eyes or rapidly turning your head to see how your eyes respond.

3. Positional Tests

Dix-Hallpike Maneuver: This is a common test used to diagnose benign paroxysmal positional vertigo (BPPV). The provider will quickly move you from a sitting position to lying down with your head tilted slightly to one side, then observe your eye movements and ask about any vertigo sensations. A positive test may indicate BPPV.
Head Impulse Test: This test assesses the vestibulo-ocular reflex by having you fix your gaze on a target while your head is rapidly turned to one side. Abnormal responses can suggest a problem with the inner ear or brainstem.

4. Hearing Tests (Audiometry)

Pure Tone Audiometry: This test evaluates your hearing ability by measuring your response to various sound frequencies. Hearing loss in one ear, particularly at low frequencies, can suggest conditions like Ménière’s disease.
Tympanometry: This test assesses the function of the middle ear and eardrum by measuring how they respond to changes in air pressure.

5. Balance Tests (Vestibular Testing)

Electronystagmography (ENG) or Videonystagmography (VNG): These tests measure eye movements and can detect abnormalities in the vestibular system (the inner ear and brain parts that control balance). ENG uses electrodes, while VNG uses video cameras to record eye movements in response to various stimuli.
Posturography: This test measures how well you maintain your balance in different conditions, such as standing on a moving platform or with your eyes closed.

6. Imaging Tests

Magnetic Resonance Imaging (MRI): An MRI may be ordered if there is suspicion of a central nervous system cause of vertigo, such as a stroke, tumor, or multiple sclerosis. MRI provides detailed images of the brain and inner ear structures.
Computed Tomography (CT) Scan: A CT scan may be used to assess for head injuries, bone abnormalities, or other conditions affecting the inner ear and surrounding structures.

7. Blood Tests

Laboratory Tests: Blood tests may be conducted to rule out underlying conditions that could contribute to vertigo, such as infections, anemia, or metabolic disorders (e.g., thyroid dysfunction).

8. Specialized Tests

Rotary Chair Testing: This test evaluates the vestibular system by measuring eye movements while you are slowly rotated in a chair. It helps to assess how well your inner ear and brain coordinate to maintain balance.
Vestibular Evoked Myogenic Potentials (VEMP): This test measures the reflexes in your neck muscles in response to sound, helping to assess the function of certain parts of the vestibular system.

Conclusion

Diagnosing vertigo involves a combination of taking a detailed history, performing physical and positional tests, and, if necessary, conducting hearing, balance, and imaging tests. The goal is to determine the underlying cause of vertigo, which can range from benign paroxysmal positional vertigo (BPPV) to more serious conditions like Ménière’s disease, vestibular neuritis, or central nervous system disorders. A thorough diagnosis is essential to guide appropriate treatment and management.