Etiological and Demographic Characteristics of Patients with Vestibular Symptoms, Retrospective Analysis

Abstract

Objectives: Vertigo and dizziness are among the most common causes of medical consultation, with an estimated prevalence of 20% and 30%. Vertigo and/or dizziness are non-specific symptoms that can be caused by various disorders including central and peripheral disorders. The present study aimed to understand etiological and demographic characteristics of patients with vestibular symptoms. Materials and Methods: Retrospective analysis of medical profiles of patients who suffered from vertigo and/or dizziness and sought medical advice from Ankara University İbn-i Sina Hospital otorhinolaryngology Department, Hearing, Speaking and Balance Disorders Center between September 2018 and September 2019 was performed. Results: A total of 444 patients between the age of 6 and 89 years were included in the study. Disregarding age groups and underlying cause, it was observed that women were more frequently affected by vertigo/dizziness. The most frequent cause of vertigo/dizziness was benign paroxysmal positional vertigo (59.23%) followed by unilateral/bilateral vestibular hypofunction (20.72%), central pathologies (14.63%). Meniere’s disease (3.60%) and vestibular neuritis (1.80%). Central vestibular disorders were found to be the most common pathology in children (53.84%). Conclusion: The most common disorder was the peripheral vestibular disorder and the most common diagnosis was benign paroxysmal positional vertigo in adults. Central vestibular disorders were recorded as the most common pathology in children. Optimal diagnosis of vertigo/dizziness related disorders requires a multidisciplinary approach.

Keywords

• Vertigo
• Dizziness
• Retrospective Analysis

Baş Dönmesi Şikayeti Olan Hastaların Etiyolojik ve Demografik Özellikleri, Retrospektif İncelemesi

Abstract

Amaç: Baş dönmesi ve dengesizlik %20-30’luk yaygınlık oranı ile tıbbi konsültasyonun en yaygın nedenleri arasındadır. Baş dönmesi ve/veya dengesizlik spesifik olmayan semptomlardır, santral ve periferik bozukluklar da dahil olmak üzere çeşitli bozukluklardan kaynaklanabilir. Bu çalışmada vestibüler semptomları olan hastaların etiyolojik ve demografik özelliklerinin anlaşılması amaçlanmıştır. Gereç ve Yöntem: Eylül 2018-Eylül 2019 tarihleri arasında Ankara Üniversitesi İbn-i Sina Hastanesi Kulak Burun Boğaz Anabilim Dalı İşitme, Konuşma ve Denge Bozuklukları Merkezi’ne baş dönmesi ve/veya dengesizlik şikayeti ile başvuran hastaların tıbbi profilleri retrospektif olarak incelenmiştir. Bulgular: Çalışmaya 6 ila 89 yaş arası toplam 444 hasta dahil edilmiştir. Yaş grupları ve altta yatan neden göz ardı edildiğinde, kadınların baş dönmesi/dengesizlikten daha sık etkilendiği gözlenmiştir. Baş dönmesi/dengesizliğin en sık nedeni benign paroksismal pozisyonel vertigo (%59,23) ve ardından unilateral/bilateral vestibüler hipofonksiyon (%20,72), santral patolojiler (%14,63), Meniere hastalığı (%3,60) ve vestibüler nörinit (%1,80) olarak gözlenmiştir. Santral vestibüler bozukluklar çocuklarda en sık görülen patolojidir (%53,84). Sonuç: Yetişkinlerde en sık görülen rahatsızlık periferik vestibüler bozukluk ve en sık rastlanan tanı benign paroksismal pozisyonel vertigo idi. Santral vestibüler bozukluklar çocuklarda en sık görülen patoloji olarak kaydedildi. Baş dönmesi/dengesizlik ile ilişkili bozuklukların optimal tanısı için multidisipliner bir yaklaşım gerekmektedir.

References

1. 1. Numata K, Shiga T, Omura K, et al. Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey. PloS One. 2019;14:e0213196.
2. 2. Barbosa F, Villa TR. Vestibular migraine: diagnosis challenges and need for targeted treatment. Arq neuropsiquiat. 2016;74:416-422.
3. 3. Staibano P, Lelli D, Tse D. A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic. J Otolaryngol-Head N. 2019;48:1.
4. 4. Walther LE. Current diagnostic procedures for diagnosing vertigo and dizziness. GMS current topics in otorhinolaryngology, head and neck surgery. 2017. doi: 10.3205/cto000141. eCollection 2017.
5. 5. Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front neurol. 2012. doi: 10.3389/fneur.2012.00169.
6. 6. Aminoff M. Vestibular laboratory testing. Electrodiagnosis in clinical neurology. Furman J, Wuyts FL. eds, Churchill Livingstone, 2005.
7. 7. Spiegel R, Rust H, Baumann T, et al. Treatment of dizziness: an interdisciplinary update. Swiss med wkly. 2017;147:51-52.
8. 8. Yin M, Ishikawa K, Wong WH, et al. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36:30-35.

9. 9. Bittar RSM, Oiticica J, Bottino MA, et al. Population epidemiological study on the prevalence of dizziness in the city of São Paulo. Braz J Otorhinolaryngol. 2013;79:688-698.
10. 10. Hornibrook J. Benign paroxysmal positional vertigo (BPPV): history, pathophysiology, office treatment and future directions. Int J Otolaryngol. 2011;2011:1-13.
11. 11. Plodpai Y, Atchariyasathian V, Khaimook W. The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10 year retrospective review. J Med Assoc Thai. 2014;97:850- 855.
12. 12. Kim HJ, Kim JS. The Patterns of recurrences in idiopathic Benign Paroxysmal Positional Vertigo and self-treatment evaluation. Front Neurol. 2017;8:690.
13. 13. Yazıcı A, İnanç Y. evaluation of BPPV with vertebral artery values.Neuropsychiatr Dis Treat. 2018;14:1975-1979.
14. 14. Parham K. Benign paroxysmal positional vertigo: an integrated perspective. Advances in Otolaryngology. 2014;2014:1-17.
15. 15. Califano L, Salafia F, Mazzone S, et al. Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis. ACTA otorhinolaryngolo. 2014;34:189-197.
16. 16. Vaduva C, Estéban-Sánchez J, Sanz-Fernández R, et al. Prevalence and management of post-BPPV residual symptoms. Eur Arch Oto-Rhino-L.2018;275:1429-1437.
17. 17. Hanley K, O’Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001;51:666-671.
18. 18. Grill E, Strupp M, Müller M, et al. Health services utilization of patientswith vertigo in primary care: a retrospective cohort study. J Neurol.2014;261:1492-1498.
19. 19. Holgers KM, Finizia C. Health profiles for patients with Ménière’s disease. Noise Health. 2001;4:71-80.
20. 20. Hendrickson M, Honaker JA. Vestibular Dysfunction, Meniere’s Disease. In: Kountakis S.E. (eds) Encyclopedia of Otolaryngology, Head and Neck Surgery. Springer, Berlin, Heidelberg, 2013.
21. 21. Hülse R, Biesdorf A, Hörmann K, et al. Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals. Otol Neurotol. 2019;40:88- 95.
22. 22. Sürmeli M, Deveci I. Clinicopathologic Results in Meniere Disease: Evaluationof 80 patients. The Medical Journal Of Haydarpaşa Numune Training and Research Hospital. 2018;58:152-157.
23. 23. Pyykkö I, Nakashima T, Yoshida T, et al. Meniere’s disease: a reappraisal supported by a variable latency of symptoms and the MRI visualisation of endolymphatic hydrops. BMJ Open. 2013;3:e001555.
24. 24. Mohamed ES. Predictors of central vestibular disorders from videonystagmography tests. Egyp J Otolaryngol. 2016;32:202.
25. 25. Neuhaser HK, Radtke A, von Brevern M, et al. Migranious vertigo. Prevalence and impact on quality of life. 2006;67:1028-1033.
26. 26. Vuković V, Plavec D, Galinović I, et al. Prevalence of vertigo, dizziness, and migrainous vertigo in patients with migraine. Headea. 2007;47:1427-1435.
27. 27. Maslarova SBSS, Soldo SB, Pajić-Penavić I, et al. Vestibular migraine considering new diagnostic criteria. Neurol Croat. 2014;63:1-2.
28. 28. Hsu LC, Wang SJ, Fuh JL. Prevalence and impact of migranious vertigo in mid-life women: a community-based study. Cephalalgia. 2010;31:77-83.
29. 29. Li CM, Hoffman HJ, Ward BK, et al. Epidemiology of dizziness and balance problems in children in the United States: a population-based study. Pediatrics. 2016;171:240-247.e3.
30. 30. O’Reilly RC, Morlet T, Nicholas BD, et al. Prevalence of vestibular and balance disorders in children. Otol Neurotol. 2010;31:1441-1444.
31. 31. Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière’s disease. Consensus document of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. Acta Otorrinolaringol Esp. 2016;67:1-7.
32. 32. Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. Consensus document of the Barany Society and the International headache society. Revue Neurologique. 2014;170:401-406.