The dizzy clinic and the dictionary (etymology and otology)

In the “dizzy clinic” it is essential to find out whether a patient has a sensation of motion (vertigo), a feeling of unsteadiness (dysequilibrium), or both. Patients often use the word vertigo incorrectly, and frequently admit that they've read about it on the internet.

The American Academy of Otolaryngology Head and Neck Surgery defines vertigo as “the sensation of motion when no motion is occurring relative to the earth's gravity, in contrast to motion intolerance, which is a feeling of dysequilibrium, spatial disorientation, or malaise during active or passive movement.”¹

However, vertigo is defined by the Oxford Dictionary of English as “a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve; giddiness.”² Interestingly, this offers “giddiness” as a synonym for vertigo. The two are perceived as different entities in the neuro-otological consultation, with giddiness having a somewhat looser implication, and potentially encompassing both vertigo and dysequilibrium.

The Oxford Dictionary of English defines giddy as “having a sensation of whirling and a tendency to fall over or stagger; dizzy,” thereby introducing another synonym (dizzy), which might be considered even less specific in terms of neuro-otological symptomatology.

The origin of the word vertigo is in the Latin vertere, meaning to turn. Conversely, the word giddy is believed to be derived from the Old English word gidig, meaning insane or, literally, possessed by a god. To complicate matters further, the word dizzy is defined by the Oxford Dictionary of English as “having or involving a sensation of spinning around and losing one's balance” and has its origin in the Old English word dysig, meaning foolish and thought to be related to Low German dusig, meaning giddy, and old High German tusic, which translates as foolish or weak.

In view of the etymological data, there is little wonder that we often struggle to elicit a clear clinical history in the dizzy clinic. Although clinicians maintain a tendency to reserve the term vertigo for a sensation of spinning or movement, our patients may well be using terms as defined by the Oxford Dictionary of English and treating the words vertigo, giddiness, and dizziness as synonymous.

The Oxford Dictionary of English has created several controversies since it was first published in 1998. Its first editor claims that it is based on modern understanding of language. It apparently derives from a “corpus linguistics of contemporary used English,” meaning that it is compiled on the basis of the way people actually use words, as opposed to the correct way to use them. The Daily Telegraph described it as a “dumbed down version of the [Oxford English Dictionary],” while a language researcher writing in the Guardian commented that “if we go on doing this, we shall create a ghetto class who can't write application letters and won't get jobs.” The reality for clinicians is that this “dumbing down” of our language might be a barrier to accurate history taking in the clinical setting.

It reminds me of something my father used to tell me: “Just because everyone else is doing it, doesn't mean its right.” Perhaps he was correct after all.