The prevalence of self-reported dizziness and that requiring medical consultation is remarkably high. Cardiac and neuropathic comorbidities, often associated with these patients confuse the diagnosis. In this multicentre study, the prevalence and characteristics of various diagnostic groups, for example, Benign paroxysmal positional vertigo (BPPV), Ménière’s and likewise were studied in 1034 consecutive patients presenting with dizziness. Various diagnostic categories relating to vestibular causes were defined and patients were placed in them. The study took into account the recurrence of dizziness which was highest in patients with BPPV and migraine associated vertigo. Imaging was carried out in 151 of the 1034 patients and 24 (15.8%) had abnormalities. Of the 150 patients with vertigo of central origin, 12 had abnormal imaging results. Of the 551 with BPPV 64 were scanned and three of them had abnormal findings of which only one could be related to vertigo. Patients with vestibular neuronitis required most sick leave and night time awakening was most frequent in patients with BPPV. The diagnostic certainty was highest for patients with BPPV. Patients with BPPV provided the largest diagnostic group. A number of interesting attributes have been mentioned for BPPV. In various studies published in the literature, the percentage of patients referred for dizziness who have vestibular causes is 14-72.9%. In one study, 52.5% of patients were diagnosed with BPPV. In this study the incidence of BPPV was highest in patients between 60-79 years of age and the author emphasised that this diagnosis should not be overlooked in elderly patients because they have an increased risk of falling. Of these patients 49% are aware of their dizziness and 85% reported that symptoms were triggered by turning over in bed. There is also evidence that awareness of BPPV is insufficient in clinicians and necessary tests are not performed. The study therefore illustrates that BPPV is the underlying cause in the majority of patients presenting with dizziness, it is easily diagnosed and treated and therefore should not be missed. 

Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness.
Lüscher M, Theilgaard S, Edholm B.
JOURNAL OF LARYNGOLOGY AND OTOLOGY
2014;128:128-33.
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CONTRIBUTOR
Madhup K Chaurasia

United Lincolnshire Hospitals NHS Trust; University of Leicester, UK.

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