How Do the Curriculum Themes Contribute?
Acute Care
Sudden vestibular failure usually leads to the patient
requesting an emergency visit. Prompt treatment and
explanation is essential.
Anatomy
Knowledge of the anatomy of the vestibular system and other
systems involved in maintaining balance is necessary to
understand the effects of the disease processes that cause
dizziness.
Behaviour
Dizziness can lead to social isolation, loss of confidence and
depression.
Biochemical Medicine
Metabolic problems such as diabetes, hypothyroidism and
hyperlipidaemia have far reaching effects and are not
confined to the ear.
Child Health
Paediatric dizziness is not covered in this study guide but is
an important topic in its own right.
Clinical Methods
As patients with a variety of clinical conditions present with
dizziness there is scope to practise a wide range of clinical
skills.
Community
Mobility problems are a major problem in the elderly and may
lead to the institutionalisation of the patient. Community
based Social Workers and Occupational Therapists have a
large role to play in those cases where patients become house
bound.
Computers and Information
Development of data bases is needed to elucidate the
“idiopathic” causes of dizziness.
Genetics
Inherited dizziness does occur in a few families.
Health Promotion, Public Health Disease Prevention and Epidemiology There is a need for a largescale epidemiology study to help to improve the diagnostic
rate and accuracy.
Infectious Diseases
Post-viral vestibular neuronitis is the commonest cause of
acute vestibular failure.
Investigative Procedures
Range from blood test to MRI depending on the diagnosis.
Medical Ethics
There are health economics issues. In a Health Service with a
finite budget should we spend money saving life or improving
the quality of life or both. There is a need for more specialist
balance clinics with proper equipment for balance assessment
and rehabilitation.
Microbiology
Study of the viruses involved in vestibular neuronitis is
needed.
Pathology
Brain stem tumours, acoustic neurinoma and cerebellopontine angle tumours are the main concerns in this topic.
Physiology
The physiology of balance is very complicated and is
probably outwith the scope of an undergraduate curriculum.
You should try and understand the mechanisms involved and
the types of nystagmus.
Research Methods
There is scope for a wide range of basic research from
aetiology through to pathogenesis.
Surgery
Cholesteatoma and tumours may be amenable to surgery but
most causes of dizziness are not.
Disability & Rehabilitation
Patients with chronic or recurrent symptoms
rehabilitative as well as therapeutic intervention.
Therapeutics/Pharmacology
You should be aware of the indications for the use of antihistamines, diuretics, anti-emetics and vestibular sedatives.
You should also be aware of the drugs which have dizziness
as a side effect.
need
Dizziness
Problem as seen by the Doctor
Problem as experienced by your patient
____________________
__
System links
Neurology/Behaviour & Psychiatry
Special Senses/Cardiovascular/Endocrine
What a doctor will be able to do:
1
2
3/4
5
6
7
What was your patient’s description of their dizziness?
Were they on any relevant medication?
What signs did you elicit?
Observe electronystagmography.
How was your patient investigated and how did these influence their
subsequent management?
What is the incidence of dizziness? Are there any preventable causes?
What difficulties did you have in gaining a clear picture of your patient’s
problem?
What system for sharing information was used for your patient? Integrated
care pathway?
How a doctor approaches their practice:
8
9
10
How is normal balance maintained and what commonly is affected to give
rise to the symptom of dizziness?
What are the economic implications of improving quality of life through
specialist balance clinics?
How is dizziness differentiated from vertigo?
Doctor as a professional:
11
12
Which professionals may be involved in the diagnosis of dizziness?
What features would give cause for concern and a request for urgent referral?