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Neurology

Diagnosing vertigo: which tests will your doctor use?

“I couldn’t walk straight, I was throwing up. At the hospital, the doctors thought I was drunk.” Werner is talking about his first ever attack of vertigo, which took him by complete surprise. (Listen to Werner’s story here). 

Understanding what is causing vertigo is crucial to effectively treating it. Vertigo is not a disease, but a symptom of various conditions,1,2 most of which are rarely serious or life-threatening, but can severely impact your quality of life.3 The good news is that with a proper diagnosis, it’s possible to get the right treatment.2 

Vertigo can be caused by several conditions, usually associated with a problem in the inner ear.1,2 These include Benign paroxysmal positional vertigo, or BPPV (Read also “Types of vertigo”), which is caused by loose crystals in the inner ear; labyrinthitis, which is an ear infection resulting from a cold or following a bout of flu; and vestibular neuritis, which is an inflammation of the vestibular nerve.2,4,5  However,  vertigo may be caused by other factors as well, such as drug-related side effects, vestibular migraine, pregnancy, and low sugar level, to name a few.5,6 (Read also “What factors can trigger vertigo”.)

To diagnose the underlying cause of your vertigo, your doctor may use different kinds of tests. These include: 

  • Physical examination: The doctor will examine your ears and check for signs of uncontrollable eye movement. He or she may also ask about your medical history to understand your symptoms better. You may be instructed to perform specific eye or head movements to evaluate dizziness. This examination helps identify any inner ear or vestibular abnormalities that may be causing your vertigo.7 Sometimes, physical examination may be sufficient to receive a proper diagnosis on the causes of your vertigo. 
  • Romberg’s test: The doctor will ask you to stand with your feet together and your arms at your side or crossed in front of you. The test consists of two parts: one with your eyes open and the other with your eyes closed. If you are unable to maintain balance when your eyes are closed, this may be due to a problem with vestibular function.7
  • Dix-Hallpike test: This involves turning your head 45 degrees to one side, then quickly lying on your back with your head off the side of the table. If you experience vertigo during this test, you likely have BPPV.7,8
  • Rotation tests: These tests involve gentle movements of the head from one side to the other while examining the eye movements. There are various types of rotation tests, such as sitting in a chair that moves laterally or focusing on a stationary object and moving the head in different directions.7
  • Hearing test: The doctor will assess the nerve connecting the inner ear to the brain. This helps identify any hearing-related issues or any problems in the inner ear that may contribute to your vertigo.7
  • Scans: If your doctor can’t find the cause of your vertigo, he or she may order a scan of your head – usually, either magnetic resonance imaging (MRI) or a computerized tomography (CT) scan.2 MRI is often used if neurological symptoms or hearing loss are present. CT scans may help your doctor see problems such as fractured or thinning bones around the inner ear.8

There are several other possible tests, such as blood work, allergy tests and vision tests, that can rule out causes of imbalance not related to the vestibular system. None of them are too invasive or challenging, and remember, the first step to effectively treating your vertigo is understanding its cause and receiving an accurate diagnosis. 

Thanks to a proper diagnosis, Werner was able to receive the treatment he needed. “Werner is now in control of his life,” says Beatrice. “He lives with vertigo, and together, we will manage it.” 

References

  1. NHS Inform. Vertigo.October 23, 2023. Accessed February 26, 2024. https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/vertigo/
  2. Stanton M, Freeman AM. Vertigo. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482356/ 
  3. Bösner S, Schwarm S, Grevenrath P, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review. BMC Fam Pract. 2018;19(1):33. Published 2018 Feb 20. doi:10.1186/s12875-017-0695-0
  4. NHS. Labyrinthitis and vestibular neuritis. Updated February 17, 2023. Accessed February 26, 2024. https://www.nhs.uk/conditions/labyrinthitis  
  5. Abbott acare. What factors can trigger vertigo? Accessed February 26, 2024. https://acare.abbott.com/en/what-factors-can-trigger-vertigo/ 
  6. Altissimi G, Colizza A, Cianfrone G, et al. Drugs inducing hearing loss, tinnitus, dizziness and vertigo: an updated guide. Eur Rev Med Pharmacol Sci. 2020;24(15):7946-7952. doi:10.26355/eurrev_202008_22477
  7. Turner H, Lavender C, Rea P. Sudden-onset dizziness and vertigo symptoms: assessment and management of vestibular causes. Br J Gen Pract. 2020;70(695):310-311. Published 2020 May 28. doi:10.3399/bjgp20X710369
  8. Penn Medicine (University of Pennsylvania). What is Benign Positional Vertigo? Last reviewed July 26, 2021. Accessed February 26, 2024. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/benign-positional-vertigo
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