The role of otolaryngologists in acute vertigo

There are many patients with vertigo or dizziness, and the causes are diverse. Although a patient with central vestibular disorder including cerebral infarction must be treated urgently by a neurologist, the patient often consults an otolaryngologist without a full examination by an internist because they often lack specific symptoms of neurological dysfunction except vertigo. We used a questionnaire to clarify the role of otolaryngologists in the treatment of acute vertigo. Replies were obtained from 29 internists and 35 otolaryngologists. Seventy percent of the otolaryngologists answered that internists should initially examine the patient with acute vertigo. On the other hand, half of the internists answered that the otolaryngologists should perform the initial exam. Most otolaryngologists think that central vestibular disorder, just like a stroke or systemic disease, should be excluded by internists at first. Otolaryngologists see many central vestibular disorder patients who were initially diagnosed as peripheral vestibular disorder with normal brain computed tomographies (CTs) and no neurological abnormalities except for nystagmus at the onset. CT can not always uncover central nervous system disorder including small infarctions or brain stem lesions, especially at onset. Although it is not always easy to establish the diagnosis of central vestibular disorder, neuro-otological examinations, especially nystagmus tests and eye movement tests, are useful to achieve this. Otolaryngologists play an important role in the differential diagnosis between peripheral and central vestibular disorders at the onset of the clinical course. The most important point in the treatment of an acute vertigo patient is cooperation between doctors of different departments.