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Dizziness, Vertigo and Balance Disorders

Dizziness disorders may require an ENT evaluation when there is a sensation of loss of equilibrium or an erroneous sensation of movement, a symptom known as vertigo. If there is a sensation of lightheadedness (about to faint), this suggests of a drop in blood pressure due to a cardiovascular problem requiring a thorough medical evaluation. Vertigo, which can occur from malfunctioning in the balance portion of the inner ear, vestibular nerve or brain, most frequently presents itself with a sensation of spinning with or without nausea. The onset is usually sudden, and may be occur when triggered by particular movements like head turns or rolling over in bed, a condition known as benign paroxysmal positional vertigo (BPPV). With BPPV, the sudden episodes of spinning are always brief (10-20 seconds) and other symptoms such as hearing loss, ear fullness or tinnitus (a subjective ringing or other sound in the ear) are usually absent. The diagnosis of BPPV is usually easily made in the ENT office on position testing, and treatment consists of physical head and neck maneuvers and exercises to reestablish normal vestibular function. Referral to a physical therapist for vestibular therapy is sometimes needed, but outcomes tend to be excellent.

Other presentations of vertigo tend to involve vertigo that is longer lasting and are more often accompanied by other symptoms. In these cases, hearing testing is generally necessary, possibly followed by more specific tests of the balance system or imaging studies of the brain and inner ear. Patients with severe disturbances of gait are generally referred to a neurologist. Treatment can include medications to reduce the severity of symptoms (unlike BPPV), and vestibular exercises and/or therapy can be helpful as well. Acute bouts of non-episodic vertigo (labyrinthitis) are generally at their worst for the first 2 to 3 days, then steadily improving but not necessarily resolving until 6 to 8 weeks after the onset of symptoms.

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