Symptom Finder - Dizziness
Dizziness
The examination of a patient presenting with dizziness begins with an otoscope examination to rule out impacted cerumen, otitis media, drum
perforation, and other middle ear pathology. The physician tests the hearing by whispering in the ear. Be sure to perform a Weber and Rinne
test as well.
Next, it is necessary to determine if there are any blood pressure abnormalities such as hypertension (particularly postural hypertension) or
hypotension. Obviously, the next important step is to look for cardiac arrhythmias or murmurs. Follow that with a more thorough neurologic examination than one usually performs in a routine physical examination.
Look for pale nails and conjunctiva or smooth tongue to rule out anemia. Finally, perform the Hallpike maneuvers. Have the patient sit with the
lower extremities extended on the examination table. After turning the patient’s head to one side at least 45 degrees, abruptly lower it until it
hangs over the end of the examination table and keep it there for at least 1 to 2 minutes. If one observes nystagmus or the patient experiences
significant dizziness or nausea, the test is positive for benign positional vertigo. Repeat the maneuver with the head in the neutral position and then to the opposite side.
The examination of a patient presenting with dizziness begins with an otoscope examination to rule out impacted cerumen, otitis media, drum
perforation, and other middle ear pathology. The physician tests the hearing by whispering in the ear. Be sure to perform a Weber and Rinne
test as well.
Next, it is necessary to determine if there are any blood pressure abnormalities such as hypertension (particularly postural hypertension) or
hypotension. Obviously, the next important step is to look for cardiac arrhythmias or murmurs. Follow that with a more thorough neurologic examination than one usually performs in a routine physical examination.
Look for pale nails and conjunctiva or smooth tongue to rule out anemia. Finally, perform the Hallpike maneuvers. Have the patient sit with the
lower extremities extended on the examination table. After turning the patient’s head to one side at least 45 degrees, abruptly lower it until it
hangs over the end of the examination table and keep it there for at least 1 to 2 minutes. If one observes nystagmus or the patient experiences
significant dizziness or nausea, the test is positive for benign positional vertigo. Repeat the maneuver with the head in the neutral position and then to the opposite side.
