Medical Legal/Worker’s Comp

  • Differentiating between physiologic and aphysiologic symptoms is a significant medical-legal problem because complaints of dizziness and unsteadiness are frequent sequela in accidental and job related injuries (mild head injury, neurotoxic chemical and drug exposure).1
  • For the neurotologist as an expert witness, the main areas of concern are hearing, and balance.2
  • Dizziness is of particular concern in medicolegal neurotology because the incidence is high, the etiology may be multifactorial, and a patient’s symptoms may have other concurrent, unrelated causes.2
  • In addition to organic disorders of the balance system, nonorganic etiologies, including anxiety, fear of falling, deconditioning, and malingering are frequently seen.3, 7
  • For those patients who may be exaggerating symptoms, the inconsistencies of symptoms, function, and vestibular testing may be inadequate to clearly determine nonorganicity.5
  • Low back pain is a leading cause of lost work days, worker’s compensation claims, and visits to physical therapy. Patients with low back pain may have impairments to the afferent and/or efferent physiologic mechanisms which control balance.6
  • Dizziness is frequently reported by litigants who have had accidental or job-related injuries. Worker’s compensation claims, disability claims, and lawsuits are filed because of this symptom.8
  • The difficulty in objective evaluation of dizziness and the potential for monetary compensation can lead to exaggeration of the severity of symptoms.8


    1. Goebel JA, et al (1997). Posturographic evidence of nonorganic sway patterns in normal subjects, patients and suspected malingerers. Otolaryngol Head Neck Surg; 117:293-301.
    2. Hart CW and Rubin AG (1996). Medicolegal Aspects of Neurotology. Otolaryngology Clinics of North America. 29(3):503-517.
    3. Coogler CE (1996). Using Computerized Dynamic Posturography to accurately identify nonorganic response patterns for postural control. Neurology Report. 20(3):12-21.
    4. Chester JB (1991). Whiplash, Postural Control and the Inner Ear. Spine 16(7):716-720
    5. Cevette MJ, et al (1995). Aphysiologic performance on dynamic posturography. Otolaryngol Head Neck Surg 112:676-688.
    6. Alexander KM and Kinney LaPier TL (1998) Differences in Static Balance and Weight Distribution Between Normal Subjects and Subjects With Chronic Unilateral Low Back Pain. JOSPT 28(6):378-383
    7. Krempl GA and Dobie RA (1998). Evaluation of Posturography in the Detection of Malingering Subjects. American J Otology 19:619-627.
    8. Gianoli G, et al (2000). Posturographic performance in patients with the potential for secondary gain. Otolaryngol Head Neck Surg 122(1):11-18.