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This review aims to assist emergency physicians in finding the underlying aetiology when a patient presents with dizziness to the emergency department. After reading this review, the emergency physician will be able to consider the most relevant differential diagnoses and have an idea about dangerous aetiologies that require immediate action. The emergency physician will also know what diagnostic steps need to be taken at what time, such as the three-component HINTS Test (Head Impulse, Nystagmus, and Test-of-Skew), which helps with distinguishing central from peripheral causes of the acute vestibular syndrome. Furthermore, episodic vestibular syndromes and chronic vestibular syndromes are discussed in detail. The five most frequent categories of dizziness are vasovagal syncope / orthostatic hypotension (22.3%), vestibular causes (19.9%), fluid and electrolyte disorders (17.5%), circulatory/ pulmonary causes (14.8%) and central vascular causes (6.4%). Given that it would neither be economical nor practical to send all patients to specialists from the start, we present general guidelines for the diagnostic workup of patients presenting with dizziness to the emergency department. This review will focus on epidemiology, aetiologies, differential diagnoses and diagnostics. Treatment is described in a separate article.

This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière’s disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus. Recommendations include clinical approaches (repositioning manoeuvres), medication (adding, removing or changing current medication depending on aetiology), vestibular physiotherapy, ergotherapy and rehabilitation, treatment of chest pain or stroke units and surgical interventions. If symptoms are acute and severe, medication with antivertigo agents is recommended as a first step, for a maximum period of 3 days. Following initial symptom control, treatment is tailored depending on aetiology. To assist the clinician in obtaining a useful overview, the level of evidence and number needed to treat are reported whenever possible based on study characteristics. In addition, warnings about possible arrhythmias due to medication are issued, and precautions to enable these to be avoided are discussed.

Objectives/hypothesis: To investigate olfactory and gustatory function in patients with maxillofacial trauma and associated fractures.Study Design: Retrospective cohort study.Methods: Olfactory and gustatory function was assessed psychophysically in 124 patients who had sustained maxillofacial trauma with an associated fracture. Five groups were defined based on the fracture type: Le Fort, mandibular, nasal, orbital, and zygomatic. Olfaction was measured with Sniffin' Sticks (threshold, discrimination, identification [TDI] score) and gustation with the taste spray method. Patients self-rated olfactory and gustatory function on a visual analog scale prior to formal testing.Results: Ten out of 124 patients were found to be anosmic (8%), with half of them found in the Le Fort (skull base) group. The Le Fort fracture group had significantly lower olfactory function than other fracture types (TDI score = 22.4 ± 10.7; P = .01; possible range = 1-48). The mean gustatory spray test score was 3.82 ± 0.4 (possible range = 0-4) without any intergroup differences. Self-rated olfactory function showed a correlation with the measured scores (r = 0.61, P < .001) across all groups.Conclusions: The present data show a significant effect of maxillofacial fracture type on the development of anosmia. Maxillofacial fractures involving the skull base, such as Le Fort fractures, are more likely to cause permanent smell loss, whereas the other fracture types are rarely associated with anosmia.Level Of Evidence: 4 Laryngoscope, 131:E331-E337, 2021. [ABSTRACT FROM AUTHOR]

Reports about fluctuating olfactory deficits are rare, as are reports of unilateral olfactory loss. We present a case of unilateral anosmia with contralateral normosmia, presenting as rapidly fluctuating anosmia. The olfactory fluctuation occurred in sync with the average nasal cycle duration. Examination after nasal decongestion, formal smell testing, and imaging revealed unilateral, left-sided anosmia of sinonasal cause, with right-sided normosmia. We hypothesize that the nasal cycle induced transient anosmia when blocking the normosmic side. Fluctuating olfactory deficits might hide a unilateral olfactory loss and require additional unilateral testing and thorough workup. [ABSTRACT FROM AUTHOR]

This review aims to assist emergency physicians in finding the underlying aetiology when a patient presents with dizziness to the emergency department. After reading this review, the emergency physician will be able to consider the most relevant differential diagnoses and have an idea about dangerous aetiologies that require immediate action. The emergency physician will also know what diagnostic steps need to be taken at what time, such as the three-component HINTS Test (Head Impulse, Nystagmus, and Test-of-Skew), which helps with distinguishing central from peripheral causes of the acute vestibular syndrome. Furthermore, episodic vestibular syndromes and chronic vestibular syndromes are discussed in detail. The five most frequent categories of dizziness are vasovagal syncope / orthostatic hypotension (22.3%), vestibular causes (19.9%), fluid and electrolyte disorders (17.5%), circulatory/pulmonary causes (14.8%) and central vascular causes (6.4%). Given that it would neither be economical nor practical to send all patients to specialists from the start, we present general guidelines for the diagnostic workup of patients presenting with dizziness to the emergency department. This review will focus on epidemiology, aetiologies, differential diagnoses and diagnostics. Treatment is described in a separate article.

This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière’s disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus. Recommendations include clinical approaches (repositioning manoeuvres), medication (adding, removing or changing current medication depending on aetiology), vestibular physiotherapy, ergotherapy and rehabilitation, treatment of chest pain or stroke units and surgical interventions. If symptoms are acute and severe, medication with antivertigo agents is recommended as a first step, for a maximum period of 3 days. Following initial symptom control, treatment is tailored depending on aetiology. To assist the clinician in obtaining a useful overview, the level of evidence and number needed to treat are reported whenever possible based on study characteristics. In addition, warnings about possible arrhythmias due to medication are issued, and precautions to enable these to be avoided are discussed.

Chronic rhinosinusitis is a common complex medical condition associated with high therapy costs and quality of life impairment. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 delineates the current standard of management of the patient with chronic rhinosinusitis for both defined disease forms: with and without polyps. Medical history and endoscopic or CT findings are needed for the correct diagnosis. Therapy of chronic rhinosinusitis aims at achieving a local disease control and reducing patients' symptoms. The center point of conservative therapy of both forms is the topical application of steroids together with nasal saline irrigations. In case of persistence of symptoms or in severe chronic rhinosinusitis with polyps, different local application methods of steroids or short systemic steroid cures should be considered. In case of insufficient disease control with conservative treatment, functional endoscopic sinus surgery is the accepted as “gold standard”. Purpose of the surgical management is opening of the sinus ostia in order to improve sinus ventilation and mucociliary clearance as well as to facilitate a wide distribution of topical drugs. Due to technical advances, endoscopic sinus has been reported to be a safe and effective procedure.