Benign Paroxysmal Positional Vertigo among Elderly Patients in Primary Health Care

Hansson, Eva Ekvall; Månsson, Nils-Ove; Håkansson, Anders

doi:10.1159/000088702

Cited by 46 publications

(19 citation statements)

References 28 publications

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“…The fact that 29% of our dizzy patients were not assigned a specific diagnosis is in accordance with other descriptions of a relatively high frequency of "unspecific dizziness" in primary care [28] or with understanding dizziness as a geriatric syndrome [4]. Our study confirmed BPPV as a relatively common [8], but frequently underestimated cause of dizziness among older people in primary care [29], although it can be easily assessed and effectively treated [30]. …”

Section: Discussionsupporting

confidence: 88%

Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

et al. 2011

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BackgroundDizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (≥65) with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs') initial diagnoses, referrals and revised diagnoses after six months.MethodsAn observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrolment and follow-up (after 1 month and 6 months). After six months, chart reviews and face-to-face interviews were also performed with the GPs.ResultsMean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8%) showed a moderate or severe dizziness handicap, and 43 (62.3%) showed a certain disability in terms of quality of life at the time of enrolment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months) initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47) than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV).ConclusionsNew-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as differential diagnosis.

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Section: Discussionsupporting

confidence: 88%

Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

et al. 2011

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“…Underdiagnoses might also be frequent, given the high rate of symptom-only diagnoses. This might be particularly so for certain vestibular disorders, such as multisensory disequilibrium (common among older patients 37 but not available as a specific ICD-9-CM diagnosis code) or vestibular migraine (common at any age but probably unrecognized by many physicians 38 ). Finally, perhaps some diagnoses were incidental to the symptom of dizziness.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of Dizziness Visits to US Emergency Departments: Cross-Sectional Analysis From a Nationally Representative Sample

Newman‐Toker

Hsieh

Camargo

et al. 2008

Mayo Clinic Proceedings

373

346

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OBJECTIVE To describe the spectrum of visits to US emergency departments (EDs) for acute dizziness and determine whether ED patients with dizziness are diagnosed as having a range of benign and dangerous medical disorders, rather than predominantly vestibular ones. PATIENTS AND METHODS A cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) used a weighted sample of US ED visits (1993–2005) to measure patient and hospital demographics, ED diagnoses, and resource use in cases vs controls without dizziness. Dizziness in patients 16 years or older was defined as an NHAMCS reason-for-visit code of dizziness/vertigo (1225.0) or a final International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of dizziness/vertigo (780.4) or of a vestibular disorder (386.x). RESULTS A total of 9472 dizziness cases (3.3% of visits) were sampled over 13 years (weighted 33.6 million). Top diagnostic groups were otologic/vestibular (32.9%), cardiovascular (21.1%), respiratory (11.5%), neurologic (11.2%, including 4% cerebrovascular), metabolic (11.0%), injury/poisoning (10.6%), psychiatric (7.2%), digestive (7.0%), genitourinary (5.1%), and infectious (2.9%). Nearly half of the cases (49.2%) were given a medical diagnosis, and 22.1% were given only a symptom diagnosis. Predefined dangerous disorders were diagnosed in 15%, especially among those older than 50 years (20.9% vs 9.3%; P<.001). Dizziness cases were evaluated longer (mean 4.0 vs 3.4 hours), imaged disproportionately (18.0% vs 6.9% undergoing computed tomography or magnetic resonance imaging), and admitted more often (18.8% vs 14.8%) (all P<.001). CONCLUSION Dizziness is not attributed to a vestibular disorder in most ED cases and often is associated with cardiovascular or other medical causes, including dangerous ones. Resource use is substantial, yet many patients remain undiagnosed.

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“…Despite the fact that BPPV is common, it has a low recognition rate in primary care, especially in older adults . It is likely that failure to diagnose BPPV correctly accounts for the high proportion of individuals who receive inappropriate diagnostics and the low proportion who receive appropriate symptom relief.…”

Section: Diagnostic Approachmentioning

confidence: 99%

A Geriatric Perspective on Benign Paroxysmal Positional Vertigo

Parham

Kuchel

2016

J American Geriatrics Society

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Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach.

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Benign Paroxysmal Positional Vertigo among Elderly Patients in Primary Health Care

Cited by 46 publications

References 28 publications

Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

Spectrum of Dizziness Visits to US Emergency Departments: Cross-Sectional Analysis From a Nationally Representative Sample

A Geriatric Perspective on Benign Paroxysmal Positional Vertigo

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