Dizziness and imbalance may have many causes and can be complicated by: complexities of gathering a clear history; the multitude of possible causes and mechanisms; and/or the simultaneous occurrence of several intersecting disorders that cause dizziness.
Author: Terry D. Fife, MD
Medical care has been divided by traditions and so-called scope of practice for many years. Otolaryngologists often see patients with hearing loss, tinnitus, dizziness and vertigo but many of these are not surgically remediable by otolaryngologists and many are not familiar with non-otological causes of dizziness. Cardiologists, internal medicine and family medicine also see patients with dizziness and imbalance and usually focus on medications, cardiogenic causes and postural hypotension. Neurologists are frequently consulted when a cause is not readily apparent, but they are most often looking for structural causes such as tumor, stroke, cerebral hemorrhage or for other neurological disorders such as Parkinson’s disease, cerebellar ataxia, spinal cord disorders or migraine. Many neurologists are less familiar with primary inner ear causes. Less frequently endocrinologists become involved, more commonly due to adrenal insufficiency and other hormonal causes. Psychiatry is sometimes involved but in the medical model is often relegated to the final evaluation since psychiatric or psychological causes are perceived by many medical clinicians as the conclusion of final resort. Sometimes this is the most obvious possible mechanism but is not considered until far less likely medical causes are investigated. The many specialties that may see a patient with complaints of dizziness or imbalance underscores the many mechanisms that may result in dizziness or unsteadiness. The end result is that many patients are shuffled from one specialist to another. Furthermore, each may conclude a different cause belonging to another specialty, leaving the patient frustrated and feeling like much of their time has been wasted and no physician takes ownership for finding a cause and devising a treatment plan.2
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- 1. Murdin L, Schilder AGM. Epidemiology of balance symptoms and disorders in the community: a systematic review. Otol Neurotol 2015;36(3):387-392.
- 2. To-Alemanji J, Ryan C, Schubert MC. Experiences engaging healthcare when dizzy. Otol Neurotol 2016;37(8):1122-1127.