Diagnosis and treatment of vertigo and dizziness
Swiss-led interdisciplinary DACH group · 2025 · Switzerland
Source and licence
- Authors
- Alexander Andrea Tarnutzer, Hassen Kerkeni, Suzie Diener et al.
- Title
- Diagnosis and treatment of vertigo and dizziness
- Journal
- Hno, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12672759
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
History taking
- Recommendation 1The search for acute dangerous causes of vertigo and dizziness should be prioritized, and special attention should be paid to accompanying neurological (e.g., double vision, [hemi-]ataxia, palsies and dysarthria), otological (otalgia, hearing loss), and cardiovascular (palpitations, arrhythmia, chest pain) symptoms [7].
- Recommendation 2History taking should always include asking about the timing (frequency, acuity, duration of single episodes), triggers (provoking factors/exacerbating factors), accompanying symptoms, and the current medication.
- Recommendation 3Overreliance on symptom quality should be avoided; thus, the type of dizziness should not lead to the exclusion of certain differential diagnoses.
Ear examination
- Recommendation 4The HINTS (plus) has a high diagnostic accuracy for distinguishing between peripheral and central causes only in patients with AVS (i.e., presenting with SN and/or GEN and acute-onset, persistent vertigo or dizziness). In the absence of any nystagmus (i.e., presenting as an AIS), a graded gait and truncal instability rating should be performed preferentially.
- Recommendation 5Positioning maneuvers are especially (but not solely) recommended in patients with intermittent, position-dependent vertigo or dizziness. Testing should always include both the posterior and the lateral canals.
- Recommendation 6All dizzy patients should undergo a neurological examination, otoscopy, and preliminary testing for hearing loss.
Chronic vestibular syndrome
- Recommendation 7In the case of BPPV, liberation maneuvers (Semont-plus/Epley for posterior canals; Gufoni/barbecue for lateral canals) should be performed.
- Recommendation 8If a stroke is suspected, immediate referral to the closest stroke unit is important, whereas in the case of suspected acute thiamine deficiency, high-dose vitamin B1 supplementation has priority.
- Recommendation 9Antivertiginous drugs and antiemetics should be taken no longer than 2–3 days in a row.
- Recommendation 10Treatment of vestibular migraine, Menière’s disease, and functional dizziness should be offered in close collaboration with a neuro-otology specialist.
Abstract
Background: Vertigo and dizziness belong to the most common leading symptoms in clinical practice. Their differential diagnosis, however, often imposes a challenge.
Objective: This work aims to provide evidence-based and practice-oriented recommendations for diagnosis and treatment of vertigo and dizziness for primary care providers.
Materials and methods: The consensus statement of an interdisciplinary working group following a national survey among Swiss primary care physicians and neurotology specialists (neurologists, otorhinolaryngologists) is presented. The associated literature search in PubMed was conducted up to October 2024.
Results and conclusion: Structured history taking and clinical neurotological examination form the basis for the differential diagnosis of the various acute (AVS), episodic (EVS), and chronic (CVS) vestibular syndromes (AVS: e.g., stroke or acute unilateral vestibulopathy; EVS: e.g., benign paroxysmal positional vertigo [BPPV], Menière’s disease, vestibular migraine, vestibular paroxysmia; CVS: e.g., bilateral vestibulopathy, persistent postural perceptual dizziness). The present paper covers the following topics: i) “red flags” for a potentially dangerous cause in patients with acute vertigo/dizziness/gait and balance disorders; ii) essential clinical neurotological examination steps; iii) diagnostic and therapeutic maneuvers for posterior and lateral canal BPPV; iv) the most important therapeutic strategies for the vestibular syndromes named above; and v) the top 10 recommendations regarding history taking, diagnosis, and treatment of vertigo and dizziness in clinical practice. This review aims to serve as a clinical companion for physicians of all specialties dealing with the primary diagnosis and treatment of vertigo and dizziness.
Supplementary Information: The online version of this article (10.1007/s00106-025-01599-z) contains supplementary material, which is available to authorized users.
Contents of the original publication
The section headings of the original.
- Preliminary remarks
- Frequency
- Diagnosis
- History taking
- Clinical examination of the acutely dizzy patient
- Performing the HINTS and evaluating stance and gait
- Clinical neurological examination in patients with spontaneous episodic or chronic dizziness/vertigo
- Positioning maneuvers
- Ear examination
- Treatment principles
- The most important vestibular disorders
- Acute vestibular syndrome/acute imbalance syndrome
- Episodic vestibular syndrome
- Chronic vestibular syndrome
- Outlook
- Practical conclusion
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