I hope you are well now - giddiness can be very debilitating and dramatically affects one's daily functioning due to their unpredictability.
If your giddiness had been a sensation of the room spinning, that would be vertigo.
If the giddiness worsened with changes of position, the most common cause would be benign positional paroxysmal vertigo (BPPV).
However, giddiness is actually a very complex symptom which can be caused by many different system disorders in our body. The giddiness symptom is not very specific, and people describe it in different ways and experience it differently. Thus, if it is recurrent or persistent, a detailed and careful examination and investigation is needed to exclude less common causes.
Even whilst evaluating for an ENT cause (50% of the cases), I would need to see if there are suspicions of non-ear related causes like:
- medications
- dehydration
- low sugar or anaemia
- poor vision
- orthopaedic/ heart/ brain disease.
Your question was how is vertigo diagnosed, and how you can get it treated.
I have found that a full battery of tests may be needed to do a complete examination of the balance system. During examination, I would check for neurological signs, eye movements, gait stability. I would do a Dix Hallpike Test to see if it is BPPV, and reposition the loose calcium stone in the inner ear during that same visit if it is indeed -BPPV.
Careful testing for positional vertigo of all 3 semicircular canals, not only the better known posterior canal, is needed, or there can be missed diagnoses. Simple checks to exclude Neck-spinal and neck-brain circulation and blood pressure changes are done.
I then get my in-house audiologist to do hearing test to exclude inner ear diseases and hearing nerve tumors as a cause of the giddiness. For the complex cases, my clinic will also be able to help with specialized tests of vestibulonystamography (VNG), VHIT, VEMP. The patient does not have to do much, as these are computerised testing and we read brain waves and monitor eye reactions.
What is most important about management is getting an accurate diagnosis. Oral anti-vertigo and anti-nausea medications help the acute giddiness. Injection of gentamicin or steroids into the middle ear may be used in specific instances, but we need to balance hearing and balance needs properly.
A course of balance rehabilitation therapy is often useful too, and it is important we teach the patients exercises that can be done at home regularly, and not only wait for their formal rehabilitation sessions.
Kind regards,
Dr Lynne Lim
