Otolaryngology Book

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Vertigo LabAka: Vertigo Diagnostic Testing

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  1. Efficacy of Lab Testing in Vertigo Evaluation
    1. British study of elderly with Dizziness (n=246)
      1. Most important/useful tests:
        1. Thorough Physical Examination
        2. Dizziness provocation
          1. Hyperventilation
          2. Head turning
          3. Romberg
          4. Postural change
        3. Posturography (detects sway while standing)
      2. Unhelpful in evaluation
        1. Blood tests
        2. Electrocardiogram
        3. ENG
        4. MRI of head and neck
    2. References
      1. Colledge (1996) BMJ 313:788
  2. Labs: Use only when indicated (helpful in <1% of cases)
    1. Complete Blood Count (CBC)
    2. Erythrocyte Sedimentation Rate (ESR)
    3. Chemistry panel (electrolytes and glucose)
    4. Syphilis Serology (VDRL or RPR)
    5. Thyroid Stimulating Hormone
  3. Diagnostic Testing
    1. Audiogram (especially if Meniere's Disease suspected)
    2. ENG (quantifies/records Nystagmus)
    3. Electrocardiogram as indicated
  4. Imaging: MRI
    1. Indicated for Vertigo with Sensorineural Hearing Loss
    2. Assess for Acoustic Neuroma or other mass lesion
    3. Consider MRA if cerebrovascular cause suspected
      1. Vertebrobasilar Insufficiency
      2. Labyrinthine artery thrombosis
      3. Anterior Inferior Cerebellar Artery insufficiency
      4. Posterior Inferior Cerebellar Artery insufficiency
      5. Subclavian Steal Syndrome
  5. References
    1. Baloh (1999) Postgrad Med 105(2):161
    2. Knox (1997) Am Fam Physician 55(4):1185

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