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Referring Physicians


There is no greater diagnostic and therapeutic challenge in medicine. When examining a patient with dizziness, start by mentally forming categories that can fit your patient’s symptoms.

Peripheral Vestibular Causes

Benign Positional Vertigo

    • Most common
    • Duration: 1-60 seconds
    • Triggered by certain head positions
    • Patient is well between attacks

Vestibular Neuritis (Labyrinthetis)

    • One incapacitating attack lasting days
    • Nausea, vomiting, often trip to ER
    • Persistent unbalance for days or weeks

Meniere’s Disease-Endolymphatic Hydrops

    • Attacks occurs while in resting position
    • Duration: 30 minutes to 4 hours
    • Often otologic symptoms: tinnitus, aural pressure, hearing fluctuations
    • May be triggered by salty foods, allergies, stress

Bilateral Vestibular Loss

    • Always unbalanced
    • Unable to read newspaper
    • Bobbing oscillopsia
    • Often after long treatment with aminoglycosides or antineoplastics

Middle Ear Disease Causes

    • Otitis Media
    • Mastoiditis
    • Cholesteatoma

Central Causes


    • History or family history positive for Migraine
    • Photophobia, phonophobia, nausea, vomiting, headache
    • Dizziness may be part of the aura preceding the headache
    • Vertigo may be the only manifestation of migraine (no headache)

Acoustic Neuroma

    • Vertigo is not a common complaint
    • Disequilibrium, subtle feeling of imbalance
    • Most common symptom: unilateral tinnitus and unilateral hearing loss

Cerebellar Infarct, Hemorrhage

    • Vertigo
    • Ataxia
    • Vertical nystagmus

Transient Ischemic Attacks (TIA)

    • Duration: 5-10 minutes

Cardiovascular Causes

    • Hypotension, hypertension
    • Vasovagal episodes

Metabolic Causes

    • Hypoglycemia
    • Diabetic Neuropathy

A carefully obtained medical history is the most important part in the evaluation of a patient experiencing dizziness.
Start with these questions:

  • When was the very first time you felt dizzy?
  • How severe was it?
  • How many days did it take to recover?
  • Are you well between attacks or always unbalanced?
  • Is the dizziness episodic or constant?
  • Is your dizziness positional?
  • Any associated symptoms?
  • Tinnitus, aural pressure, hearing changes, nausea, vomiting, anxiety, headache?
  • Any relations with certain foods, allergies, stress?

When should you refer your patient to an otolaryngologist? Any patient with suspected peripheral vestibular causes, tinnitus, hearing loss or middle ear disease should see a specialist.

Call us at 612-339-2836 or toll-free at 866-316-0769 to refer your patient for an appointment, or submit an online referral.

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Minneapolis, MN 55454
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