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eConsult Clinical Question

A 43-year-old patient reports that she has dizziness with head movement and with walking and standing. She states it feels that the room is spinning. She states that she has had this since having COVID but that it is getting worse. She is uninsured. I recommended physical therapy and previously she has been self-adjusting her blood pressure (BP) meds and has some anxiety and depression. Any other thoughts or recommendations for the treatment of her dizziness?

eConsult Response

If the dizziness truly involves circular spinning sensations, then vestibular (balance) testing would be a useful next step. If the "spinning" sensation is more of an unsteadiness or presyncope/fainting sensation, then I would agree with continuing the focus on BP meds and/or anxiety and depression treatment.

Vestibular testing can be a challenge for uninsured patients due to the expense of the testing process, which usually involves several hours of different tests (wobble platform, spinning chair, etc.). Lower-cost alternatives, if the full vestibular testing protocol is too expensive while uninsured, would include a physical therapy balance assessment. Regarding COVID-19, many patients have nonspecific neurologic symptoms including hearing loss/tinnitus, loss of smell, cognitive dysfunction, etc., but there haven't been many official reports of balance-specific symptoms, so the standard balance assessments are still the current standard of care, without any new changes unique to COVID-19.  

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.