A detailed history of your problem is the most crucial information needed by your healthcare professional in order to diagnosis true vertigo from general dizziness, to determine a cause for the vertigo, and then to implement appropriate treatment.
Your healthcare professional will ask you to describe your symptoms in detail. As explained above, true vertigo is more than just a general feeling of dizziness or lightheadedness, but rather a false sensation of spinning or rotating within your environment or your environment spinning or rotating around you.
Your healthcare professional will want to know when the first episode of your vertigo occurred, how long it lasted, and if it was associated with any other events such as a car accident, head trauma, or an illness or infection.
They will also want to know how often you have experienced the vertigo since the first episode, and the general pattern of symptom frequency. Your healthcare professional will ask if anything in particular triggers your symptoms such as moving your head in a certain direction or getting out of bed. They will also inquire about any other related symptoms such as nausea, vomiting, falls, visual disturbances, feelings of fullness or pressure in the ear, ringing in the ear, hearing loss, headaches or if you have a history of migraines. Your healthcare professional will also want to know if there is anything that makes your symptoms better, if you are taking any medications, or if you have a family history of any inner ear disorders or central nervous disorders.
Your healthcare professional will then perform a physical examination. They will look in your eyes to note any nystagmus and may do a basic examination of your ears by looking into them. A general examination of your balance will be completed and they may ask you to lie down and then get up from the lying position in order to determine if it brings on your symptoms. A general examination of the joints of your neck will also be completed to rule out any symptoms coming from the neck region. Other general physical examinations such as blood pressure in both lying and standing may also be assessed.
Dix-Hallpike’s manoeuvre is a test that can be done by your healthcare professional in their clinical setting. This tests helps to determine if certain head movements are the cause of your vertigo. If positive this test can also determine which ear is the problem.
During this test your healthcare professional turns your head to one direction then assists you to quickly lie back while maintaining your head position and also hanging your head over the edge of the bed. Your healthcare professional watches your eyes for whether nystagmus occurs and also assesses the direction and quality of it.
After you sit upright for a few minutes to allow recovery, the same test is done with the head turned to the opposite direction.
The tests that can be done in your healthcare professional’s clinic in order to definitively determine the cause of your vertigo are limited. Depending on what your health care professional finds on their initial examination they may send you for a battery of other tests to further determine the cause of your vertigo.
Nystagmus, as previously explained, is an involuntary movement of the eyes. Nystagmus can indicate a problem with your balance system, particularly the nerve that runs from your ear to your brain (vestibulocochlear nerve) or the nerve that runs from your eyes to your brain (optic nerve).
Electronystagmography (ENG) is a commonly used test to check for signs of nystagmus in more detail.
To conduct this test electrodes are placed around the eye and the movements of the eye are recorded as you are asked to follow certain moving targets or while your head is positioned in different directions. A related test is one in which the eye movements are video recorded by wearing goggles rather than electrodes (videonystagmography).
During this test, which is a subtest of electronystagmography, cool and warm water or air is administered to each ear, one at a time. The change in temperature stimulates the balance organ in the ear and in normal circumstances your eyes reflexively move in a specific direction depending on whether cool or warm water is administered. Absence of this movement indicates a vestibular problem.
Normally each time your head moves one way your eyes move in the opposite direction. During rotation tests electrodes or goggles are used to record how the eyes move while the head is moving at differing speeds. You may be asked to move your head while looking at a fixed target, or a computerized chair may be used to rotate your head while it is restrained.
Simple rotation tests may be administered by your healthcare professional in their clinical setting. For these tests they will observe your eyes while they move your head or rotate you on a swivel chair.
Vestibular evoked myogenic potential (VEMP)
This test is used to confirm whether or not the saccule and part of the vestibular nerve are functioning properly.
During this test headphones are used along with electrodes over the neck muscles. For this test the saccule, which also responds to sound, is stimulated via loud clicks into the headphones rather than via head movements. The response of the neck muscles to the clicks is recorded and indicates whether the sensory impulses are being transmitted properly.
Sometimes called computerized dynamic posturography, this test provides information about motor control and balance function during varying unstable conditions. Rather than providing specific information about the vestibular portion of the ear or brain, this test focuses on the feedback needed by the receptors in one’s joints, muscles, and skin (proprioception) in order to maintain one’s balance.
During this test you are required to stand on a moveable platform and you are asked to focus on a specific target. The platform or the target is then moved while pressure gauges under the platform record and map your body’s sway in relation to a neutral standing position.
In some cases a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan of the brain may be done. An MRI scan uses a strong magnetic field and radio waves in order to produce a detailed image. A CT scan uses a series of detailed X-rays to create an image.
These scans can identify abnormal growths affecting the ear (tumors both benign or malignant) or lesions such as those seen in MS.
Standard hearing tests are often carried out when delineating the cause of vertigo due to the close relation between the hearing and balance organs and nerves of the ear.