[The Management of the Vertiginous Patient]

In neuro-otology, history taking still represents the most important instrument. It comprises type, direction, duration, intensity and influencing factors of dizziness, vertigo and balance problems as well as accompanying symptoms of the otologic and neurologic systems. A distinction in a) acute persisting, b) episodic with or without positioning dependence and c) chronic vertigo can provide a first diagnostic differentiation. The clinical exam contains an otolaryngologic and neurologic assessment with focus on ocular motor function, nystagmus, head impulse testing, balance function tests, cerebellar signs and positioning tests. Helpful laboratory tests are tests of orthostatic function, pure tone audiometry, bithermal calorics, video head impulse test and in specific situations nystagmography and the recording of vestibular-evoked myogenic potentials. Often a brain magnetic resonance tomography needs to be added. In several cases a multi-disciplinary approach is recommended. Therapeutical options are physical therapy as vestibular rehabilitation or repositioning procedures, drugs or surgery, albeit the level of evidence of some therapies currently being applied is far from satisfactory.