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Dizziness is one of the most common complaints with which patients present. In spite of this the cause often remains undetermined and this is due to the complexity of the equilibrium system, the numerous causes of dizziness, and the fact that these are not confined to the area of expertise of any particular medical specialty. The general practitioner must be able to evaluate dizzy patients and be able to identify serious problems or conditions that are specifically treatable, and know when to ask for special tests or to refer. Basic Physiology. Symptoms of Vertigo
Patients usually express a wide variety of symptoms as dizziness. By analyzing patient complaints some alteration of the sense of equilibrium can fall under the following terms:
  1. Vertigo: Illusion of movement relative to one’s surrounding, usually rotatory but may be linear. This sensation usually suggest peripheral vestibular system disorders.
  2. Dysequilibrium or imbalance: Usually patients complain of unsteadiness related to ambulation. This suggests peripheral nervous system or cerebellar disorders.
  3. Pre–syncope: Feeling of faintness or impending loss of consciousness and usually related to cardiovascular disorders.
  4. Light headedness: Non specific sensation of unsteadiness or floating.
  5. Duration of symptoms: Sudden onset or intermittent symptoms usually indicate a peripheral cause while more constant or progressively worsening symptoms indicates central cause.
  6. Associated symptoms: Hearing loss, ear fullness, tinnitus and ear discharge indicate peripheral vestibular pathology. Nausea and vomiting are commonly associated with all types of dizziness but may be more marked when the peripheral vestibular system is involved.
  7. Exacerbating factors: Symptoms that worsen with head movement indicate a peripheral and more benign etiology, symptoms that worsen with closing the eyes indicate a peripheral vestibular cause and symptoms worsened by loud noise suggest perilymphatic fistula.
  8. Medical history: History of autoimmune disease, hyperlipidemia, cerebrovascular accident, migraine, seizure, cancer, syphilis and previous ear surgery may be relevant to patient symptoms. All drugs taken currently should be recorded for the possible risk of ototoxicity.
Physical examination
The examination should include a detailed history and physical examination of the patient. The physician also examines the ear to look for evidence of infection. In addition tests of hearing should be done.

Balance and co–ordination should be tested
Investigations of Vertigo Treatment of Vertigo Differential diagnosis of vertigo
Vertigo can be a manifestation of an ear ailment, brain disorders (eg. brain tumor like acoustic neuroma), or a systemic illness (eg.: vasculitis). The vertigo can also be related to migraine, head position (benign positional vertigo), cervical spondylosis, side effect of drug therapy (eg. gentamicin).