You are seeing Mr. Rodriguez, a 31 year old man, because he often feels dizzy. Take a focused history and perform the Dix-Hall Pike maneuver.
History
- Clarifies symptoms are descriptive of vertigo (‘the room spinning around’)
- Duration of dizziness
- Frequency
- Associated activity, especially head turning
- Other precipitants
- Aural fullness (none)
- Decreased hearing from one ear
- Tinnitus (none)
- Otalgia (none)
- Syncopal episodes
- Chest pain or shortness of breath
- Nausea or vomiting
- Vision changes
- Sensory deficits (none)
- Motor deficits (none)
- Trauma to either ear
- Previous episodes of otitis media
- Smoking and alcohol history
- Effect on daily activities
Dix-Hallpike Maneuver
- Explains procedure to patient, and what they might expect
- Asks patient to lie down and tilts head back and towards one side
- Repeats maneuver on opposite side
- Comments that they are looking for geotropic nystagmus towards affected ear
- Comments on reversal when leaning toward non-affected ear
Case 5 – Dizziness