Assessment of Balance

Classify the timing and triggers before choosing tests. Dizziness may arise from vestibular, neurological, cardiovascular or other systemic disease. ^{SAEM GRACE-3}

Exclude an acute central cause first. New focal signs, severe gait and/or truncal instability, new deafness or a concerning acute headache require urgent assessment; an apparently peripheral feature may be red herring. ^{NICE NG127}

Time course: onset, first event vs episodic, duration of each attack, frequency, progression and function between attacks. Separate a brief trigger-dependent spell from continuous vertigo that merely worsens when the head moves.

Triggers: rolling in bed/looking up, standing, exertion, visual motion, loud sound and pressure/straining. Clarify whether the trigger starts symptoms or aggravates symptoms already present.

Associated features: hearing change, tinnitus/fullness, headache, migraine sensitivity/aura, diplopia, dysarthria, dysphagia, altered sensation, limb weakness, palpitations and loss of consciousness. Ask directly; neurological or auditory symptoms may not be volunteered.

Context: vascular risks, migraine, neuropathy, visual impairment, trauma/ear surgery, ototoxic drugs, sedatives/alcohol and cardiovascular medicines. Document falls, injury, mobility, work, driving and avoidance.