Vertigo and dizziness - Common Complaints

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Simply assigning a diagnosis of vertigo could prematurely terminate the evaluation and thereby miss an opportunity for accurate diagnosis followed by appropriate treatment. In some cases, the term vertigo is used as shorthand for benign paroxysmal positional vertigo.

Because of the high prevalence of this disorder in the outpatient setting, these patients may receive proper treatment despite sloppy documentation and failure to convey accurate information to colleagues. This chapter primarily focuses on the symptom of vertigo in patients admitted to the hospital.

Vertigo and Dizziness : Common Complaints

Chapter includes cardiac causes of presyncope. Other medical illnesses, drug toxicity, and substance abuse that may produce symptoms of dizziness and vertigo are covered elsewhere in this book. The published studies reviewing a systematic approach to the diagnosis and treatment of the symptom of vertigo relate to the outpatient or emergency room settings. Hospitalized patients are a different population. If symptoms of dizziness and vertigo are new experiences, the clinician should consider iatrogenic causes in addition to the usual suspects.

CASE A year-old woman with diabetes and hypertension underwent a total knee replacement. On the first postoperative day, she experienced vertigo when turning in her hospital bed. Each brief vertiginous episode was associated with mild nausea. The patient was essentially asymptomatic when sitting or lying still. Forgot Password? What is MyAccess? Otherwise it is hidden from view. Forgot Username? About MyAccess If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

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Case Files Collection. Clinical Sports Medicine Collection. Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Enable Autosuggest. Previous Chapter. Next Chapter. As an inclusion criteria on this study, the subjects should have undergone a complete audiologic evaluation, including vocal and tonal audiometry and impedanciometry; the subjects should have presented dizziness for more than 6 months and be older than 15 years older.

Any subject who presented evidences of a central vestibular dysfunction 18 , severe hearing loss 19 and tympanometric curve of B kind that suggested presence of liquid in the medium ear would be excluded from the sample. After having signed the informed consent term, all subjects underwent to an interview, with the purpose of verifying the fact, the time and intensity of hearing and vestibular signs and symptoms. The interpretation criteria of vestibular exam were followed according to the propositions by Mangabeira-Albernaz et al Such material is made of an auto perception questionnaire which evaluates the dizziness associated to the incapacities and handicap in the three areas of a patient's life: Physical, functional and emotional.

Thus, the minimum punctuation would be 0 points not representing handicap and the maximum would be representing maximum handicap , being 28 points 7 items for the physical aspect, 36 points 9 items for each of the functional and emotional aspect. As the Original Brazilian DHI does not present handicap interpretation in degrees, the punctuation of this project has been distributed into 4 degrees, for matters of analysis: 0 to 25 points without handicap , 26 to 50 points mild handicap , 51 to 75 points moderate handicap and 76 to points severe handicap.

In order to establish a relationship between the punctuation of DHI and the several variables studied a descriptive and a statistics analysis have been performed. After the performance of otoneurologic exams and the punctuation obtained at the Brazilian DHI, the results have been compared, aiming at relating the vestibular signs and symptoms with the conclusion of the vestibulometry and the total handicap of the subjects.

Graph 1. Score distribution of DHI on patients with vestibular complaints. All Issues.

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    Author s :. Key words:. Vestibular system. Quality of life.

    Physical Examination

    The distribution of the total Brazilian DHI with the functional, emotional and physical aspects and its respective averages, standard deviation, mode, median, minimum and maximum of each is demonstrated on Table 1. The punctuation of the evaluated subjects has been significant with an average of The scores of the Brazilian DHI have been related with age and gender variables and are not considered statistically significant Tables 2 and 3.

    Out of 27 subjects with dizziness complaint, 16 Thus, the presence of tinnitus has been related with the total values of the Brazilian DHI as it can be observed on the following Table 4. Among the subjects that presented tinnitus, the period of installation of such symptom has been taken into account if it started in 1 year, in 1 year and a half or in 2 years. The time of tinnitus has been close among those who had such symptom in 1 year Similarly to what happens with the tinnitus, the period of dizziness has also been taken into account and can mostly be seen in the subjects who have had it for 1 year The intensity of dizziness has also been related with the Brazilian DHI values, which are mostly shown, at the intermediate degree, in 10 The kind of dizziness, that is, if it is rotatory or not, or both, has been another variable analyzed.

    The presence of nausea, sweating and paleness, which are considered neurovegetative symptoms were mentioned in In the vestibulometry, all the evaluated subjects have presented regular calibration of ocular movements. The spontaneous nystagmus has been absent with open eyes, and with closed eyes it has been presented in 10 subjects, but its direction and velocity have been within the normal standards. The evaluated subjects were different in the research concerning the positional and post caloric nystagmus, making an individual discussion of each performed test necessary.

    Concerning the investigation of positional nystagmus, most of the subjects Five subjects It has not been possible to obtain the Jongkees Rate in two subjects due to the intensity of the neurovegetative symptoms presented in the warm tests, but its responses were found normal.

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    The conclusion of vestibulometry revealed The medical literature demonstrates that it is more frequent in female subjects and affects more adult and elderly people 21,22, Despite of the higher number of women and of people between 42 and over 61 years old in the investigation, those variables are not related to the increase of handicap. The analyzed data are in accordance with the medical literature, which have not found any relation between sex and age with the incapacities severity 3,11,24,25, As the presence of tinnitus is analyzed, it can be observed that this has been a factor that called the attention for the contribution of the handicap for dizziness in those subjects, although it has not been significant.

    In a sample with a higher number of subjects, such result may be different. On the other hand, the 3 subjects with Brazilian DHI with severe degree presented associated tinnitus and dizziness, while no subject under this handicap range holding tinnitus has been found.

    Those data may make us think about the contribution of the union of two or more symptoms for the increase of incapacities, reflecting on the life quality of the subjects. A higher emotional suffering is common in patients with complaints of three or more symptoms. The medical literature has demonstrated that the tinnitus itself brings handicap to the lives of the subjects 27, As the period of both symptoms have been closely related, this helps us to understand better the interference of tinnitus in the handicap for dizziness in those subjects.

    In relation to fact that the intensity and kind of dizziness not being determinant in the handicap degree, the literature has controversies about it, once there are authors that state that the high frequency and severity of dizziness have been associated with the high negative impact in the life quality and in the limitation of daily activities 8,29 , and others believe that the low levels of dizziness and unbalance many times may be enough to maintain a handicap and significant suffering. We believe that the influence of other variables may have a higher weight in the determination of the incapacities, such as profession, personality and life style.

    Depending on what the subject does during their day-by-day, the functioning of the vestibular system needs to be harmonic between the years. This way, mild dizziness, flotation sensation or unbalance should be enough to refrain them from their professional duties. This way, we can realize that the characteristics of the physical symptoms were not determinant for the incapacities profile of dizzy subjects. Psychological conditions of depression and anxiety are important factors in order to determine the problem degree caused by the dizziness.

    The frequency distribution of patients with high impact on daily activities, on life quality and on fear of a coming dizziness, presented high rates in the patients' responses who were affected by psychological suffering 8. Concerning the vestibulometry, the findings are different from other studies' findings 6. No harm has been found on the life quality significantly associated with the vestibulometry findings. Although most of the evaluated subjects Thus, we believe that two or more people may have the same diagnosis and the same kind of dizziness, but be differently affected.

    This way, all the symptoms that follow dizziness, as well as the handicap profile and its incapacity analysis, will suffer some kind of interference according to their life style, to their expectations, motivations and psychological situation. That is why the description of a dizzy patient is very particular, once it gathers all those variables and even the role that the subject has at work, at home and in society.

    Because of that, we realize the importance of handicap questionnaire in clinics practice, once the clinical exam and vestibulometry are not enough to investigate the functional and emotional parts of dizziness.

    Many times the harm degree on those areas influences in the patient's attendance to the doctor's office and makes us understand why there are some labyrintopathy patients that look for treatment and some that do not. Maybe the agglutination of such procedures in the clinic routine provides more specific data which allow the definition of the best behavior and counseling with the dizzy patient. The introduction of questionnaires in the clinical routine aids, among other things, the reduction of discrepancy found in the doctor's and patient's opinion.

    The psychological factors, which are difficult to be evaluated, contribute for the differences found in the evaluation between doctor and patient in the impact that dizziness causes in the subject's health 8. The application of Brazilian DHI and of any other questionnaire could be useful in the clinical situation of the patient, once it helps the doctor with their treatment plan, as well as with the indication of psychological intervention, for example.

    Dizziness: A Diagnostic Approach - American Family Physician

    Besides, the questionnaires could also be one of the parameters to verify the possibility of the subjects to be candidates of Vestibular Rehabilitation therapy, having more acceptances to this treatment, after realizing their own difficulties during the questionnaire application. For the professionals that work in the otoneurological area, the application of the self-perception questionnaire will be a valuable and useful clinical instrument and should be included in the clinical evaluation and also in the evolution monitoring of any patient with vestibular complaint.

    Although the clinical experience shows that dizziness may bring psychosocial consequences, there are not many projects in the Brazilian literature that cover this issue with more details, like it happens with hearing loss, about which there are many investigations. It would be interesting that new projects be developed, using the Brazilian DHI in more investigations, or even comparing different handicap questionnaires, trying to improve the life quality of patients with vestibular complaint. Evaluation of health-related quality of life in individuals with vestibular disease using diseasespecific and general outcome measures.

    Phys Ther ; 77 9 Tratamento da vertigem e de outras tonturas. Cohen H.