Understanding Vestibular and Balance Disorders:
Dizziness is one of the most difficult complaints to assess because it is a subjective sensation that cannot be directly and objectively measured. Dizziness frequently represents many separate overlapping sensations that can be caused by a multitude of different pathophysiologic processes. Dizziness also is one of the most common patient complaints seen in ambulatory care today and therefore clinicians in almost all disciplines will be faced with evaluating this difficult problem. Evaluation and treatment of patients with dizziness will differ significantly once the category of dizziness has been determined.
True Vertigo Versus Other Types of Dizziness
A vestibular disorder is almost always described as a sensation of spinning and is accompanied by nystagmus that patients may report as a feeling that their eyes were rapidly snapping or jerking to and fro. This will relate to a sensation that the environment around them is moving. Patients with non-vestibular dizziness may describe a spinning sensation inside the head; they do not have nystagmus and thus do not report movement of the environment. Those patients with vestibular dysfunction may equate the feeling to a sensation of having motion sickness and describe feelings of imbalance, as though they were falling or leaning to one side. Those patients describing their symptoms with terms such as “lightheaded . . . swimming . . . giddiness . . . floating” most often have a non-vestibular etiology for their dizziness.
Head Impact Injuries
The Center for Disease Control (CDC), estimates that each year over 20 million children and adults will suffer from concussions, mild traumatic brain injuries (TBI), or head trauma as a result of sports injury, falls, motor vehicle accidents and blunt force trauma. Head impact injuries cause disruption of participation in sports, work, and recreational or just everyday activities. Symptoms associated with head impact trauma may include: dizziness, nausea, blurred or double vision, imbalance, hypersensitivity to light, and cognitive impairment.