ABSTRACT
Dizziness and postural instability are common presenting complaints in patients seen
in otolaryngology practice. Unfortunately, these patients frequently do not receive
optimal evaluation and therapy because of the difficulty in obtaining a thorough yet
pertinent history and the perceived complexity of the physical examination. Over the
last 10 years, we have utilized a standardized approach to evaluation of the dizzy
patient that is user friendly and maximizes the time and effort spent by the clinician.
First, a thorough history is taken from the patient in two forms: (1) a specially
designed questionnaire filled out well before the examination and (2) a direct interview
using the answers on the questionnaire as a guide. During the physical examination,
emphasis is placed on the following subtests: (1) spontaneous nystagmus; (2) central
oculomotor function; (3) the vestibulo-ocular reflex (VOR) battery-headshake, head
thrust, dynamic visual acuity, and Hallpike positioning; (4) coordination; (5) posture;
(6) gait; and (7) special examinations. This neurotologic examination is completed
in about 10 minutes and is performed as a battery of tests following the routine otolaryngologic
and/or neurologic examination. We feel that this test sequence is thorough yet easy
to perform and ideally will demystify the examination of these challenging patients.
KEYWORD
Vertigo - physical examination - balance - vestibular ocular reflex
