Eli's Rehab Report

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If your practice is like most, dizziness is one of your clients' most common complaints -- but the solution isn't always adding on more therapy.

When patients complain of persistent dizziness and nothing seems to be offering them relief, your best next step could be to consult with an audiologist, says Jaynee Handelsman, Ph.D., VP for professional practice in Audiology at the American Speech-Language-Hearing Association and assistant director of the Vestibular Testing Center at the University Of Michigan Hospitals and Health Systems.

Why: Dizziness that endures despite medical intervention can be a sign of inner ear disorder or vestibular system dysfunction -- and those are the issues audiologists are trained to both evaluate and in some cases treat, Handelsman says.

Often, the audiologist can determine whether a patient needs vestibular physical therapy, is experiencing sensory loss secondary to trauma, or has been exposed to toxic agents, among other potential problems. Collect this information to help your patient's audiologist get the full picture:

• When did the symptoms begin?
• Are the symptoms ongoing or episodic?
• If episodic, are the symptoms spontaneous or provoked by head movement?
• Are the symptoms associated with auditory symptoms (e.g., tinnitus, aural fullness, hearing loss, etc.)
• Are there any other relevant health concerns that might impact postural stability (e.g., diabetes, orthopedic problems, etc.)

Watch out: Dizziness is commonly mistreated with medications to suppress the vestibular system "without knowing whether the patient's symptoms indicate an inner ear asymmetry, bilateral vestibular loss, or something else entirely," Handelsman warns.

While those medications may manage severe vertigo and vegetative symptoms in the short term, they may prevent the patient's system from compensating from a peripheral vestibular loss and could worsen the problem, particularly when bilateral vestibular loss is present, she says.

Better: "When dizziness is persistent, send the patient to an audiologist for a comprehensive evaluation, to uncover the root of the problem and uncover whether there's an issue with the patient's vestibular system," Handelsman suggests.

Of course, the patient's symptom profile and medical health history are the most important components in the evaluation of patients with dizziness and balance problems. It is important to be aware of potential risks of falling and to make referrals to other professionals when appropriate.

Coordination of care: Once the dizziness' root cause is uncovered, patients' treatment plans should be updated to reflect their needs. For instance, "a patient with motion-provoked dizziness is a good candidate for vestibular physical therapy and should be referred to a PT with expertise in working with patients with balance disorders," Handelsman says.

And if a patient's symptoms are caused by something that affects other sensory systems and/or speech and language abilities, audiologists should work as part of a multi-specialty team to best meet the needs of the patient," she affirms.