Managing the dizzy patient By Maddison Brennan, Balance Audiologist, Subiaco Dizziness is a nondescript symptom meaning something different to each individual. The term is commonly used by patients to characterise sensations including vertigo, imbalance, presyncope, and light-headedness. Over one third of Australians over the age of 50 experience some dizziness or vertigo. The differential diagnosis of dizziness is complex. One third of patients are still symptomatic after a five-year period and only one in four ever receive treatment for their dizziness. Even for benign paroxysmal positional vertigo, studies show the average time from symptom onset to diagnosis can be 19 to 70 months. Undiagnosed and untreated dizziness can significantly impact quality of life. The psychological impacts include increased social isolation, anxiety, and depression. Dizziness can lead to lost work time and reduced productivity. In the elderly, it is associated with reduced physical activity and an increased falls risk. For the majority of patients, a thorough history will make the diagnosis and inform treatment. This history would include temporal features, associated auditory or wider symptoms, and any specific triggers.
Key messages
Dizziness is common Accurate assessment is needed to inform treatment
Vestibular rehabilitation can improve symptoms. A formal assessment of the vestibular system with an audiologist can offer supplementary information to facilitate diagnosis and management. Test results include objective, side-specific, and receptor-specific information.
a vestibular lesion, doing so through assessing the vestibuloocular reflex. Caloric testing’s pitfall is that it only measures the horizontal semicircular canals. Video head impulse testing (vHIT) complements caloric testing and can assess function of all six canals, helping to better localise peripheral lesions.
Vestibular Rehabilitation
Videonystagmography (VNG) utilises an infrared video system attached to goggles to monitor and record eye movements. The VNG battery includes a series of subtests evaluating different components of the peripheral and central vestibular system, including preliminary tests for central lesions. Electrophysiological testing is performed to assess auditory evoked potentials, including vestibular evoked myogenic potentials (VEMP). VEMP testing assesses the function of the otolith organs and is a valuable diagnostic tool in the diagnosis of semicircular canal dehiscence.
Vestibular rehabilitation therapy (VRT) is the foundation of treating many causes of dizziness. The vestibular pathway demonstrates a high degree of neural plasticity and the aim of VRT is to facilitate central compensation. Successful VRT results in improved gaze stability, reduced dizziness, improved postural stability and gait, and helps patients restore normal function and activity. VRT has been demonstrated to show both subjective and objective improvements in a patient’s symptoms. – The author wishes to acknowledge the input of Ellen Putland in the writing of this update. Author competing interests - nil relevant disclosures.
Caloric irrigation remains the gold standard for diagnosing peripheral
Quality of life post-prostate cancer treatment continued from Page 43 An artificial urinary sphincter, which is patient-operated, is 90% effective in severe incontinence. The complication rate (parts failure, infection erosion) is higher than with a sling.
Erectile dysfunction (ED) This is commonly pre-existing in the those being treated for prostate cancer with 50% at age 50 having 44 | JULY 2020
some ED, increasing 10% per decade post-surgery most will have severe ED which may improve over 1236 months. Erectile nerve sparing correlates with recovery but is not always possible with locally advanced or high-grade cancers ED management can be nonsurgical. This includes penile rehabilitation early post-op with PDE5 inhibitors, vacuum device and intracavernosal injections to maintain penile tissue health whilst
awaiting nerve function recovery. Penile prostheses may be inflatable (effective with high patient and partner satisfaction). Complications include infection and parts failure. Malleable implants are simpler with less complications but also less effective. Author competing interests – nil
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