Vestibular History Taking- Key Elements

In the field of vestibular therapy, taking a thorough vestibular history is crucial. Accurate diagnosis of vestibular conditions (i.e. vestibular migraines) often depends solely on the patient’s history. When I first entered this field years ago, I was advised to focus on three primary elements during vestibular history-taking: symptoms, tempo, and circumstance. Over time, this approach has proven invaluable in my practice.

In this post we'll cover these three elements along with a useful acronym that will help gather all of the pertinent information.

Key Components of a Vestibular History

1. Symptoms

To begin, determining the nature of the patient’s symptoms is essential. Is our patient experiencing vertigo, dizziness, or unsteadiness? Sometimes this can be a challenge though as patients often struggle to describe their symptoms accurately. Some even recommend keeping it simple by using the term, "dizziness experience".

In addition to their dizziness experience, ruling out the remainder of the “5 Ds” is critical:

• Diplopia (double vision)
• Dysarthria (difficulty speaking)
• Dysphagia (difficulty swallowing)
• Drop attacks (sudden falls without loss of consciousness)

If any of these other D's are present, referral to neurology becomes imperative. Or, when patients report aural symptoms such as ear pain, pressure, tinnitus, or hearing loss, an otolaryngology consultation should be considered.

2. Tempo

Next, understanding the tempo of symptoms is a critical component of a thorough vestibular history. The duration and frequency of symptoms provide significant insights into the underlying condition. Therefore, consider asking the following questions:

• How long do the symptoms last? Do they last seconds, minutes, hours, or days?
• Are the symptoms recurrent, or do they persist continuously?

This understanding of the tempo can help differentiate between various vestibular conditions. For example, Benign Paroxysmal Positional Vertigo (BPPV) typically involves brief episodes of vertigo, while Ménière’s disease is characterized by longer, recurrent episodes.

3. Circumstance

Additionally, understanding the circumstances surrounding the onset and triggers of symptoms is essential. These factors provide valuable diagnostic clues that are vital in developing an accurate diagnosis. When taking a vestibular history, it is important to ask the patient about:

• Triggers: Do factors such as head movements, positional changes, visually busy environments, pressure changes, stress, hormonal fluctuations, or dietary factors trigger symptoms? Or, do the symptoms come on spontaneously?
• Initial Onset: Was the onset of symptoms associated with any specific event or change, such as a new medication, illness, change in diet, or significant stress?

By understanding the circumstances that trigger symptoms, you can narrow down the potential causes of the symptoms, especially when you combine this with the information about the symptoms and tempo.

Additional Tool: The “SO STONED” Acronym

For those who prefer acronyms to help them, the “SO STONED” acronym serves as a helpful tool to ensure all vital aspects of the patient history are covered:

• Symptoms: Vertigo, dizziness, unsteadiness, etc.
• Occurrence: How often do the symptoms occur? (Daily, weekly, monthly, irregular)
• Since: When did the symptoms begin? (Days/weeks/months/years ago, and was there any precipitating factor?)
• Triggers: What causes or aggravates the symptoms? (Head movements, positional changes, visually busy environments, pressure changes, stress, spontaneous onset)
• Otological Symptoms: Are there any ear-related symptoms? (Tinnitus, hearing loss, fullness in the ear, ear pressure, hyperacusis)
• Neurological Symptoms: Are there any associated neurological symptoms? (Diplopia, dysarthria, dysphagia, drop attacks, headache, photophobia, phonophobia, loss of consciousness, tingling)
• Evolution: How have the symptoms evolved over time? (Initially worse, improving, worsening, fluctuating)
• Duration: How long do the episodes last? (Seconds, minutes, hours, days, continuously)

Conclusion

In conclusion, taking a comprehensive vestibular history is the cornerstone of accurate diagnosis and effective treatment in vestibular therapy. Whether you adhere to the classic approach of assessing symptoms, tempo, and circumstance or prefer to use the “SO STONED” acronym, gathering a detailed vestibular history is essential for ensuring successful patient outcomes.

I hope that you found this post helpful. If you are interested in further training in vestibular therapy, be sure to visit our website. There you can access our FREE monthly emails and other learning opportunities. Additionally, don’t forget to explore our YouTube channel at North49Physio for more educational content.