Review symptoms, including spinning sensation, imbalance, nausea, hearing changes, headache, and triggers

Check medical history, including recent illness, head injury, migraines, ear problems, medications, and cardiovascular conditions

Perform a physical examination, including ear, neurological, eye, gait, and balance assessment

Check vital signs, including blood pressure and heart rate

Perform positional testing, such as the Dix-Hallpike maneuver

Assess eye movements for nystagmus

Evaluate hearing with bedside hearing tests or audiometry

Review medication use for possible side effects or toxicity

Order blood tests if indicated, such as glucose, CBC, electrolytes, thyroid tests, or B12

Order imaging if indicated, such as MRI or CT of the brain

Refer for vestibular testing if needed, such as VNG, ENG, or rotary chair testing

Consider cardiovascular evaluation if fainting, palpitations, or orthostatic symptoms are present

Seek urgent evaluation for severe headache, weakness, speech changes, chest pain, or sudden hearing loss