Hearing And Balance
In the evaluation of a patient complaining of dizziness, the examiner's initial efforts must be directed at determining the exact nature of the patient's complaint because the pathophysiology determines the patient's sensations. Precisely understanding the complaint determines the workup. For example, in a patient with syncope or presyncope, the cause of the sensation is probably cardiovascular and not inner ear. In contrast, in a patient with a sensation of spinning or whirling, the pathology probably involves the inner ear or vestibular nerve on 1 side, though insults to the cerebellum and brainstem may also produce true vertigo. Therefore, the cause in a patient with true vertigo cannot be assumed to be peripheral.
Although close questioning and careful examination usually reveal important differences, conditions such as multiple sclerosis, migraine equivalent, and vertebrobasilar transient ischemic episodes may simulate peripheral vestibulopathy. Vertigo, the hallmark of inner ear disease, is defined as the illusion of movement of either one's self or one's environment.