The Ten-Minute Examination of the Dizzy Patient

, Department of Otolaryngology, Division of Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.

Semin Neurol. 2001;21(4) 

In This Article

Abstract and Introduction


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.


Objectives: On completion of this article the reader will be able to perform a thorough screening examination for patients presenting with dizziness, establish at the bedside the difference between central and peripheral mechanisms, and generate an appropriate differential diagnosis.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the author's relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the author of this article.