Disorders of balance cause the patient to present in different clinics like
ENT, cardiology, neurology and geriatric medicine, and thus different specialities
develop different protocols for evaluation and treatment in their own areas of
expertise. Thus focused ways of treatment while having some advantages often
cause doctors to overlook signs and symptoms other than their own speciality
and further causes problems like unnecessary expensive investigations being
done. This puts a strain on the patient’s scarce resources in developing countries
and also burdens health care systems in developed countries that have to bear
the cost of repeated referrals and expensive investigations often with no clear
diagnosis.
In tertiary care, all patients with giddiness should be screened with the
questionnaire and those identified as symptomatics require Bithermal caloric
testing to identify the site and side of the lesion before specific treatment is
started. The use of cold caloric test as a screening test should be discontinued
forthwith
