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13; Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness <span>Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications &

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Dizziness/Vertigo
Dizziness/Vertigo Approach to patient with Dizziness Subjective “Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?” Yes = vertigo BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common) brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting Vestibular Neuritis rapid onset, severe, persistent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications Objective Assessment viral labyrinthitis benign positional vertigo Eustachian tube dysfunction (often with s

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