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Linear head movements and the center of gravity are sensed by the utricle and saccule. Turning movements of the head are sensed by the semicircular canals. Head motion is sensed by the vestibular labyrinth and by vision. A complete medication history is essential and needs to include over-the-counter and illegal drugs because these can produce vertigo and disequilibrium. Many medications used to treat seizures, depression, anxiety, and pain affect the vestibular system and the central nervous system. Neurologic disorders tend to cause constant vertigo or disequilibrium and usually have other symptoms of neurologic dysfunction associated with the vertigo. General health problems such as diabetes mellitus, heart disease, atherosclerosis, and neurologic disorders can cause vertigo. Therefore, also ask about hospitalizations for infectious illnesses, renal, or heart disease, common reasons for the administration of ototoxic antibiotics or diuretics.Ī family history of vertigo and hearing loss suggests hereditary degenerative processes in the inner ear. Patients may not be told that their medication is ototoxic. Past history of ear infections, head trauma, and ototoxic medications must be elicited. History of ear pain, drainage, or ear trauma is important to determine disease originating in the ear. Positional vertigo is extremely common and, in most cases, of inner ear origin. Specifically ask whether change in head position brings on or changes the symptoms. In intermittent vertigo the frequency, time interval, and duration should be noted. Slowing of the pulse is sometimes noted in vertigo of inner ear origin very rapid or irregular heartbeat suggests cardiac arrhythmia as the underlying problem. Nausea and vomiting frequently accompany inner ear disorders loss of vision, slurred speech, or loss of consciousness suggests central nervous system or cerebrovascular disorders. Tinnitus, ear pressure, or hearing loss not only suggests the inner ear as the location of the disorder but also points out the involved ear.
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We need to determine whether the lesion is central or peripheral and the side the lesion is on.Īsk the patient to describe the major symptom as to onset, duration, and severity, and for other symptoms that occur at the same time. The objectives of the history are to obtain a clear description of the symptoms and associated symptoms and to gather information that will help locate the lesion. Differential Diagnosis of Vertigo, Disequilibrium, and Related Disorders.