What’s so important about dizziness anyway?

Our book Dizziness: Why You Feel Dizzy and What Will Help You Feel Better, has just been published, and several people have asked me why my co-author, Dr. Robert W. Baloh, and I wrote the book. What’s so important about dizziness, anyway? All agree it’s common, but a cause or explanation for dizziness may elude experts. We wanted to smooth the path to getting answers--for patients, families, and health care providers.

Many of our patients have recently been discharged from a hospital, where a dedicated group of doctors has performed numerous tests. The medical team has often discharged the person home with a diagnosis of “vertigo” and no particular treatment plan.

Some people come to clinic with folders of hospital records. These seldom help, unless a doctor has written down a relevant neurological exam finding. Often, there is no such documentation. Or the critical finding may exist only as a single line within hundreds or thousands of pages—a needle in a haystack. I love to get the whole haystack. In many cases, though, the patient has only the discharge instructions. Kind of like a piece of straw instead of the haystack.

Dizzy people in our clinics are frequently found to have one of a handful of common inner ear disorders. One resident at a prestigious hospital limited notes on dizzy patients to a statement that the patient either does or doesn’t have Meniere’s. That’s ridiculous. But at least the resident considered a real, named disorder and applied criteria. A diagnosis was ruled out. By comparison to the experiences of many with dizziness, being told “You do not have Meniere’s” is remarkably sophisticated.

A second common scenario in specialty dizziness clinics is this. The person with dizziness has a problem that was missed in part because of distraction by the possibility of an inner ear or “labyrinthine” disorder. Historically, the labyrinth was a mythical, complicated and nearly inescapable maze. The metaphor of a labyrinth reflects the way doctors and patients feel, confronted with the possibility of an ear disorder. Overwhelmed, lost, distracted, and wandering aimless.

Here is a recipe for doctors and others interested in diagnosis. First, write down the most common inner ear disorders. A reasonable starting point is to Google “Journal of Vestibular Research” and “International Classification of Vestibular Disorders.” If the dizzy person’s symptoms do not match those of the disorders described, forget about the inner ear for a moment.  Pretend the patient has any other arbitrary symptom. Weight loss. Or weight gain. It almost doesn’t matter. Once people escape the labyrinth, it is sometimes easier for them to listen. And paraphrasing William Osler: “If you listen to the patient, she will tell you the diagnosis.” This makes it all the more important to quickly determine when dizziness is substantially unrelated to the labyrinth.

For those who want to short circuit the complexity of specialty consensus criteria, my co-author and I have written a book that we hope will serve as a rough guide to diagnosis. We hope to have enlivened the material by including stories about our patients and describing how the ideas of our specialty developed. We weren’t able to cover every possible explanation of dizziness. Instead, we describe the most common disorders in a format we hope is accessible to patients, families, doctors and anyone interested in the fascinating question of how to overcome dizziness and maintain balance.

Gregory T. Whitman, MD, is an otology and laryngology instructor at Harvard Medical School and an otoneurology specialist at Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital. He is the co-author of the new book, Dizziness: Why You Feel Dizzy and What Will Help You Feel Better. He tweets @GregWhitman.