Vertigo, Dizziness, and Hearing Loss

Dizziness and vertigo are common complaints that can be troubling or disabling for the patient. Diagnosis begins with obtaining a clear description of the symptoms, their onset, duration, and provoking factors. Vertigo, an illusion of motion, usually has its origin in the vestibular system but the cause may be peripheral (inner ear) or central. Dizziness due to orthostatic hypotension can be diagnosed by taking blood pressures lying and standing. Light-headedness or syncope may be a sign of orthostatic hypotension. Gait imbalance or dysequilibrium may have vestibular, motor, sensory, or multiple causes. Physical examination should be directed at the ears, hearing, vestibular system, and neurologic examination. Ancillary tests including audiometry, VOG, and MRI will usually establish the diagnosis, and effective treatment can then be offered. With the exception of ruling out an acoustic neuroma, MRIs are generally not useful in diagnosis of vestibular disorders. Hearing loss is prevalent in older adults but can occur at any age. Examination of the ears and audiometry will establish the diagnosis, and a proper treatment can usually be given. Hearing aids will benefit the majority of patients with moderate to severe degrees of hearing impairment. Cochlear implants are recommended to patients who can no longer derive benefit from hearing aids. Children with suspected hearing loss should always be referred to an audiologist; no child is too young to test, and early intervention has a profound influence on outcome. Unilateral hearing loss requires exclusion of acoustic neuroma. Sudden hearing loss should be evaluated urgently and treated with steroids. Hearing loss in the elderly may contribute to decreased cognitive function, and should not be ignored. A successful treatment for the mal de débarquement syndrome, which may follow voyages on the sea or occur spontaneously, can relieve the troubling rocking, swaying, or bobbing that is a prominent part of this syndrome.