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The value and function of the vestibular system may often be underestimated when considering the various special senses that we possess. However, of all the special senses, vestibular dysfunction may cause the most significant determent for our daily function and survival. Millions of people present annually to their physician with the complaint of dizziness. The goal of this chapter is to discuss the common disorders that affect the vestibular system and provide a framework for the evaluation, diagnosis, and treatment of patients with vestibular disorders.

Unilateral injury to the peripheral or central vestibular system causes asymmetry in the baseline input into the vestibular centers and this causes vertigo, nystagmus, vomiting, and a sense of falling toward the side of the injury. Vertigo is defined as the illusion of movement. However, the chief complaint of patients with injury to the vestibular system is usually not vertigo but dizziness. If the complaint is clarified to be vertigo, the duration, periodicity, and circumstance of the vertigo and the presence of other neurological signs or symptoms allow for categorization of the vertigo.

By its proximity to and its shared embryologic origin with the auditory system, hearing loss may be coupled with vestibular symptoms. The role of the otolaryngologist is to determine if the patient’s vestibular symptoms are due to injury to the peripheral vestibular system and to differentiate peripheral from central vestibular disorders. The evaluation includes a complete head and neck and vestibular examination (Table 58–1). The diagnostic evaluation includes audiology, vestibular testing, and imaging. Knowing the duration of the vertigo or disequilibrium and the presence or absence of hearing loss allows for a narrowing of the differential diagnosis (Table 58–2). The vertigo may be due to injury of the peripheral or central vestibular system. Often, the presence of other neurological abnormalities leads to an investigation for a central cause of the vertigo. However, central vestibular injury due to a lesion or stroke may mimic a peripheral vestibular disorder.

Table 58–1Steps in a vestibular evaluation.

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