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The evaluation of vertigo includes five components:

• Medical History
• Physical Examination
• Laboratory Evaluation
• Vestibular Function Tests
• Other Diagnostic Tests As Needed

Medical History

The medical history of the patient is very important since the description of each symptom, together with duration and precipitating factors, is crucial for establishing a correct diagnosis. Approximately 75% of patients with vertigo can be diagnosed based on medical history alone. Important points to relay to the health care provider during the medical history include:

• When the dizziness started
• Nature of the dizziness (e.g., lightheadedness, spatial disorientation, or a sense of spinning or rotation)
• What triggers the symptoms
• The intensity of the symptoms
• How long the symptoms last
• What brings relief and how long it takes for relief to begin
• Whether the dizziness comes and goes or is persistent
• Any associated symptoms such as nausea, vomiting, tinnitus, deafness, or fullness in the ear
• List of all medications being taken
• Any stress, anxiety, or depression that you may be experiencing

Physical Examination

Since there are so many potential causes of vertigo, it is important for the physician to evaluate various functions relating to the nervous system, including hearing and vision. Some parameters that may be evaluated during the physical examination include:

• Eyes - examination may include vision test and looking carefully into the eyes to examine the visible structures, and eye motion at rest and during various vestibular tests
• Ears - physician may look for signs of infection or perform a hearing test

• Integrated functions of the nervous system, such as:

  • reflexes of arms and legs
  • standing in place without swaying
  • steadiness while walking

Laboratory Evaluation

Usually there is no need for routine blood tests to evaluate vertigo, unless it is necessary to exclude a suspected underlying medical condition. These tests may include:

• Complete blood count (CBC)
• Thyroid function tests
• Syphilis screen
• Erythrocyte sedimentation rate (ESR)
• Autoimmune antibodies
• Rheumatoid factor

Vestibular Function Tests

Vestibular function tests evaluate and confirm the diagnosis of vertigo by introducing causes that trigger vertigo and examining various aspects of the patient's responses. Vestibular function tests include:

• Dix-Hallpike Maneuver
• Electronystagmography
• Rotational Chair Testing
• Computerized Dynamic Posturography

Dix-Hallpike Maneuver

The only diagnostic test that confirms the diagnosis of benign paroxysmal positional vertigo is the Dix-Hallpike Maneuver (also called the lateral head-trunk tilt). In this test, the patient sits on a table with their head rotated 45 degrees to one side. Maintaining the head position, the individual is moved quickly from a sitting to lying position with their head tipped back edge of the table.

The test is positive if the patient experiences vertigo and nystagmus. Specifically, the response would include:

• A short latent period before the onset of nystagmus
• Rotatory nystagmus within 40 seconds
• Reversal of nystagmus when the patient is brought back up to a sitting position (this is not always evident)
• Fatigue of nystagmus response when the procedure is repeated
• Duplication of vertigo with repetition of test

The ear is on the underside of the face when the response to the test is positive is the ear that is causing the vertigo. The nystagmus and sensation of vertigo usually dissipate or weaken after about 30 seconds if the head is held still. When the person is returned to the sitting position, there may be a mild recurrence of dizziness which usually abates quickly. When the unaffected ear is tested (on the underside when lying down), there are no symptoms of vertigo or nystagmus.