Otolaryngology: Open Access
Open Access

Abstract

Objective: To present a systematic approach to the practical management of the dizzy patient in the office setting. This approach is based on the experience from the Multidisciplinary Neurology Clinic of the University Health Network, Toronto General Hospital. Method & Results: The dizzy patient presents challenges in a busy clinic even for an experienced physician. Having a consistent systematic approach will minimize the time required to reach a most probable diagnosis so that further investigations can be directed appropriately. With a carefully directed history and by following our four by four approach we have found that in >90% of the dizzy patients the cause can be confidently diagnosed. The distinction between dizziness and the true vertigo can be made by allowing the patient time to describe their feelings in their own words. Patients with true vertigo have vestibular pathology which can be peripheral or central in origin. Peripheral vestibular disorders are often associated with other inner ear symptoms such as hearing loss, tinnitus and aural fullness. Patients with central vestibular disorders are more likely to have complaints of focal neurological dysfunction, for example diplopia, dysphagia, parasthesia or paresis. Clinical examination of a dizzy patient should include a relevant otological and neurological examination. Conclusion: By following our four by four method physicians can diagnose majority of the dizzy patients. Special vestibular tests and diagnostic maneuvers are valuable and easy skills to learn for assessment of the dizzy patient.

Biography

Ahmad Al Alamadi graduated from Glasgow Medical School in United Kingdom in 1993 and completed his training in Scotland by obtaining his Fellowship of Royal College of Surgeons of Glasgow in 1998. He followed his higher surgical training by doing a clinical neurotology fellowship program in Toronto University in Canada. He is currently a consultant Otologist and Neurotologist and Medical Director at Al Baraha Hospital in Dubai. He is also a Clinical Associate Professor at Sharjah University. His expertise lies in Otological surgeries and management of dizzy patients.