Diagnosing the Dizzy

Rocksprings, Texas, resident Henry Greistmann, 67, recently went to his doctor for a check on his ears. When he told the doctor he got dizzy when he looked up at the ceiling, he was sent to a balance and dizziness clinic hosted by four local physicians.

The clinic, held every other Wednesday, pulls the expertise of a local audiologist, Jeff Sirianni; internal medicine specialist, Michael Schlabach; neurologist, Anand Mehendale; and ear, nose and throat specialist, Charles Ballay.

"Dizziness problems are almost always due to a combination of several things, including hypertension, arthritis, inner ear problems, and those combine to make someone dizzy," Schlabach said. "We try and diagnose what is happening."

The patients are evaluated individually by all four doctors, who then meet for a roundtable discussion at the end of the day to compare findings and talk about possible treatments.

More than 50 percent of the patients are experiencing benign postural positional vertigo, a treatable condition that commonly is felt by bending over, straightening up and becoming dizzy.

"It's really important to recognize the signs early," Schlabach said.

Sirianni said there are many things that can cause these disorders.

"It's very difficult for general physicians to diagnose," he said. "This is why we get together. We see our patients in a very narrow scope and time frame. Here at this clinic, we get to put pieces together, and it's much more efficient for the patient. Balance problems can fluctuate, especially if they are going to see one specialist one week, two weeks later they go see another one and so on. It's much more efficient for the patients."

Mehendale said years ago, all balance and dizziness issues were commonly diagnosed as a lack of blood flow to the brain. That no longer is the case.

"If you see 100 patients who have balance issues, there could be 250 reasons for those issues," he said. "We figure out what we can treat through things like vestibuler therapy, platform rehab and nerve conduction studies. If blood is restricted to the center of the brain, that is a serious stroke warning, but it is very rare. With BPPV, we can totally cure, and significantly manage the other issues."

Most patients to the clinic are referred by their primary care physicians or the emergency room.

Ballay said even though it could be a combination of factors leading to the symptoms, occasionally, the group "hits a homerun" and catches a major issue before it leads to a stroke or death.

"We've found aneurysms, tumors and seizure disorders," he said. "You've got to stay on your toes. There could be a litany of diagnosis and my job is to figure out if it is related to the ear. All this is meant to cover the bases at our clinic. It's convenient for the patient and all of the doctors can get together and discuss at the end of the day. I learn a lot from the other doctors, and in a small town like Kerrville with our elderly population, it's a tremendous benefit. The main thing is to get to the patients before they experience a fall."

Why it's important

In patients older than 65, nearly 20 percent die within one year of experiencing a fall.