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Dizziness, vertigo common, warrant attention in primary care, research suggests

Wednesday, November 05 2008 | Comments

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What's This? Dizziness and vertigo are frequent symptoms that warrant increased attention from primary care providers, cross-sectional study data suggest.

The study investigators noted that previous research suggests dizziness and vertigo are among the most frequent complaints in primary care, but the cause remains unexplained in 40% to 80% of cases. To evaluate the contribution of vestibular vertigo to the burden of dizziness and to assess the overall burden of dizziness in the community, they studied a sample of adults representative of the German population.

Participants (n=4,869) were drawn as a random sample of participants of the German National Health Interview Survey 2003. Of these, 1,157 reported having a history of moderate or severe dizziness or vertigo. A total of 1,003 of those individuals underwent validated neurotologic interviews to differentiate vestibular vertigo from nonvestibular dizziness (response rate, 87%).

Of the 1,003 participants, 243 had vestibular vertigo and 742 had nonvestibular dizziness; in 18 cases, a distinction could not be made between vestibular vertigo and nonvestibular dizziness.

The researchers determined that dizziness/vertigo had an annual prevalence (in the last 12 months) of 22.9% (95% CI, 21.5%-24.3%) and an annual incidence (first episode of dizziness/vertigo in the last 12 months) of 3.1% (95% CI, 2.6%-3.8%) among community-dwelling adults aged 18 to 79 years. Incident dizziness/vertigo led to sick leave, medical consultation, or interruption of daily activities in almost two-thirds of cases, the authors noted. The annual prevalence and incidence rates of vestibular vertigo were 4.9% (95% CI, 4.2%-5.7%) and 1.4% (95% CI, 1.0%-1.8%), respectively.

The annual medical consultation rate for incident dizziness/vertigo was 1.8%.

Both vestibular vertigo and nonvestibular dizziness were associated with reduced physical and mental quality of life in an age- and sex-adjusted analysis.

As compared with nonvestibular dizziness, vestibular vertigo was more frequently followed by medical consultation (70% vs 54%; P<.001), sick leave (41% vs 15%; P<.001), interruption of daily activities (40% vs 12%; P<.001), and avoidance of leaving the house (19% vs 10%; P=.001).

Observing that previous studies have probably underestimated the contribution of vestibular vertigo to the burden of dizziness in the general population, the researchers reported that vestibular vertigo accounted for 34% of incident cases of dizziness/vertigo and 21% of prevalent cases in the 12 months prior to the study.

"According to our study, vestibular vertigo accounts for one-third of dizziness/vertigo symptoms in the medical setting," the researchers concluded. "[M]ore attention should be given in primary care to frequent vestibular disorders, in particular to benign paroxysmal positional vertigo, for which effective and inexpensive treatment with positioning maneuvers is available and easy to perform not only by specialists but also by those in primary care." (Neuhauser HK, et al. Arch Intern Med 2008;168:2118-2124.)

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