How Do Doctors Evaluate Dizziness?

Doctors evaluate dizziness by taking a patient's medical history and doing lab work, scans and other tests.

Dizziness is a common symptom among patients visiting the doctor. The doctor will first look for other signs and symptoms to check if the dizzy spells are a sign of a life-threatening condition. Most dizzy spells are not serious.

The doctor will confirm if you just have dizziness or if you have something else such as vertigo. Dizziness is a feeling of lightheadedness, fainting or a mild feeling of imbalance. Vertigo is the feeling that the stationary things around you are moving.

The doctor will first evaluate you physically. If they suspect that you have suffered a stroke or have a head injury, they will order an immediate computerized tomography (CT) scan or magnetic resonance imaging (MRI).

To evaluate dizziness, the doctor will take your medical history and look for the following clues

• Hearing impairment
• Anxiety
• Trauma
• Onset and progression of the symptom
• If the episodes are associated with turning the head, lying supine or sitting upright
• If the dizziness is preceded by a viral infection or respiratory illness such as a cold
• If there is any accompanying headache
• If you have diabetes, a heart problem or hypertension

During the physical examination, your doctor will evaluate you for any problems while walking such as maintaining balance. They will also check if the major nerves of your brain are functioning properly. For this, they perform various tests that include

• Eye movement testing: Your doctor will track your eye movements while you focus or look at a moving object.
• Head movement testing: The doctor may do simple head movement tests called the Dix-Hallpike maneuver and Supine Roll test to check if you have benign positional vertigo (BPM). Other tests known as the head thrust test or head impulse test may also be done to check if you have peripheral vestibular dysfunction.
• Posturography: With this test, the doctor will check how well you balance on bare feet under various conditions.
• Rotary chair testing: You will be asked to sit in a computer-controlled chair that will move at varying speeds.

Your doctor may ask for additional tests to look at your heart health, as dizziness can also be a sign of a heart condition.

Treating dizziness involves treating its underlying cause. The possible causes include

• An ear infection
• Hypoglycemia (low blood sugar level)
• Migraine
• Dehydration
• Heat exhaustion
• Stress
• Anxiety
• Anemia (iron deficiency)
• Motion sickness
• A sudden drop in blood pressure
• Problems in the inner ear such as labyrinthitis
• Medication side effects

Dizziness often does not require treatment. It goes away on its own within a couple of weeks. Treatment can help you to manage the symptoms. It involves medications and balance exercises.

• Medications
  • Diuretics: For Meniere’s disease, there are medications known as diuretics that help reduce the volume and pressure of the fluid in the middle ear. Examples include Microzide (hydrochlorothiazide), Dyrenium (triamterene) and Diamox (acetazolamide).
  • Antihistamines and anticholinergics: These help relieve dizziness and nausea.
  • Anti-anxiety medications: Your doctor may prescribe medication such as Valium (diazepam) and Xanax (alprazolam) if anxiety is causing your dizziness.
• Vestibular rehabilitation: This is a type of balance therapy to regain balance control. It helps you to learn the techniques to balance in response to motion.
• Psychotherapy: If anxiety or stress gives you dizzy spells, psychotherapy can be helpful. Your doctor will refer you to a psychiatrist, psychologist or other mental health providers.
• Injection into the ear: Your doctor may inject the antibiotic gentamicin into your middle ear.

Rarely, doctors recommend surgery, called labyrinthectomy, to treat dizziness. It involves the removal of the entire middle ear organ (labyrinth).