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Updated: Dec 12, 2025

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[Effective diagnostics for vertigo, dizziness and equilibrium disorders].

F Schmäl1

  • 1Schwindelambulanz am Zentrum für HNO Münster/Greven, Maria-Josef-Hospital GmbH, Lindenstr. 37, 48268, Greven, Deutschland. schmael@zentrum-hno.de.

HNO
|August 14, 2020
PubMed
Summary
This summary is machine-generated.

Diagnosing vertigo and dizziness involves answering key questions, performing bedside tests like the HINTS exam, and utilizing instrument-based vestibular examinations. These steps help pinpoint the cause of equilibrium disorders.

Keywords:
NystagmusPositional vertigoVideo head impulse testcVEMPoVEMP

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Area of Science:

  • Neurology
  • Otolaryngology
  • Vestibular System Science

Background:

  • Vertigo, dizziness, and equilibrium disorders present with diverse etiologies.
  • Accurate diagnosis is crucial for effective management and patient outcomes.

Purpose of the Study:

  • To outline a systematic diagnostic approach for vertigo and dizziness.
  • To detail the application of clinical bedside tests and instrument-based examinations.

Main Methods:

  • Initial assessment includes four cardinal questions regarding vertigo characteristics.
  • Bedside examination involves searching for spontaneous nystagmus using the HINTS (Head Impulse, Nystagmus, Test of Skew) test and positional testing for Benign Paroxysmal Positional Vertigo (BPPV).
  • Instrument-based tests include caloric examination, 3D video Head Impulse Test (vHIT), cervical and ocular Vestibular Evoked Myogenic Potentials (cVEMP, oVEMP).

Main Results:

  • The HINTS test differentiates peripheral from central disorders.
  • Caloric testing assesses the horizontal semicircular canal and superior vestibular nerve.
  • vHIT analyzes all semicircular canals and vestibular nerves; cVEMP and oVEMP evaluate saccule and utricle function, respectively.

Conclusions:

  • A comprehensive diagnostic strategy combining clinical evaluation and instrumental testing leads to definitive or suspected diagnoses.
  • These diagnoses guide further investigations, such as radiological imaging for suspected conditions like vestibular paroxysmia or vestibular schwannoma.