Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey

Abstract

Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07–0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06–0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01–5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07–0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01–0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85–61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

“…8.26%). Stroke/TIA-rates among ER patients reported in the literature range between 3.2% up to 18% [2,12,24]. Cerebellar infarctions can present as AVS ("pseudoneuritis").…”

“…Recent work in a Canadian cohort showed that there are major training deficits in final year otolaryngologists with regard to vertigo diagnostic testing, more specifically the bedside head impulse test [16,19]. A survey-based study emphasized interdisciplinary differences between otolaryngologists and non-otolaryngologists with regard to vertigo diagnosis and treatment practices [24]. Interdisciplinary thinking between neurology, ENT, and internal medicine, is much needed not only to appropriately detect, diagnose and treat life-threatening causes of VD, but also with regard to the high number of unspecified diagnoses termed, demanding an interdisciplinary, holistic view of dizzy patients.…”

“…VD is responsible for major costs within both the emergency department and the inpatient setting [16]. Resource use has been found to be disproportionally high for ER patients with VD symptoms, especially with regard to diagnostic imaging [24]. As could be seen from the HINTS-studies, clinical testing shows a better detection rate of strokes in acute AVS than cranial imaging (MRI or CT) [11].…”

Drug–Drug Interactions in Vestibular Diseases, Clinical Problems, and Medico-Legal Implications

“…Metoclopramide had a similar efficacy to dimenhydrinate in reducing vertigo, nausea and vomiting in an emergency setting [ 245 ]. Metoclopramide (non-specific compound) is commonly prescribed in the management of MD, BPPV, VN, and other forms of vertigo [ 73 ].Metoclopramide is metabolized to mono-de-ethyl-metoclopramide at least in part by CYP2D6 isoform, and possibly CYP1A2 and CYP3A [ 97 ].…”

Assessment of Saudi Physicians and Physical Therapists' Adherence to the Updated Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo: A Cross-Sectional Study

“…11 Unfortunately, researchers still found variations in the management of BPPV among clinicians from different specialties. 17,18 To improve quality of care and clinical reasoning accuracy, evidencebased guidelines have come into clinical practice. 19 A clinical practice guideline (CPG) for BPPV management was developed and recently updated by the American Academy of Otolaryngology, Head and Neck Surgery Foundation (AAO-HNSF).…”