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This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness.
Method
This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018.
Results
A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary ‘pre-vestibular function testing balance diagnosis’, which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients.
Conclusion
Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing.
This chapter focuses on the most frequent vertigo syndromes. Characteristic symptoms of Benign paroxysmal positioning vertigo (BPPV) include brief, in part, severe attacks of rotatory vertigo with and without nausea, which are caused by rapid changes in head If the typical positioning nystagmus can be elicited without any additional central signs and symptoms. Menière's disease is typically a combination of abruptly occurring attacks with vestibular and/or cochlear symptoms, fluctuating, slowly progressive hearing loss and, in the course of time, tinnitus. Vertigo and nausea are reduced by antivertiginous drugs used in other acute disorders of labyrinthine function, for example, dimenhydrinate 100 mg as suppository or benzodiazepine. The differential diagnosis of perilymph fistulas includes the following illnesses: BPPV, positional vertigo of central origin, Menière's disease, vestibular paroxysmia, somatoform phobic postural vertigo, labyrinthine trauma and bilateral vestibulopathy. Differentiating vestibular migraine from transient ischemic attacks, Menière's disease or vestibular paroxysmia can occasionally be difficult.
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