Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study

Risk factors for imaging abnormalities in patients with dizziness complaints: an algorithm for ordering brain imaging

AIM

The diagnostic detection of abnormal findings with head imaging is low for dizziness. This study aimed to investigate the risk factors associated with abnormal computed tomography (CT) or magnetic resonance imaging (MRI) findings for patients with dizziness.

MATERIALS AND METHODS

Medical records of patients who had CT or MRI examinations for dizziness complaints between January 1, 2019, and December 31, 2020, were retrospectively reviewed. Imaging outcomes were grouped as normal or abnormal findings. Risk factors, including demographics, dizziness pattern, symptoms, comorbidities, and medical history were assessed. A Chi-square automatic interaction detection decision tree model was used to classify abnormal imaging findings based on risk factors identified through multivariable analyses.

RESULTS

A total of 2,342 scans were examined. Detection of abnormal findings was 4.8% (n = 96), including acute cerebral infarction (n = 33), acute cranial hemorrhage (n = 15), cancer/tumor-like lesions (n = 27), and inner ear abnormalities (n = 21). The risk factor most indicative of abnormal findings were loss of consciousness and neurologic deficit (Odds Ratio 55.57, p < 0.001). The likelihood of abnormality indicating acute brain lesions was 44.4% for patients with loss of consciousness and neurologic deficits. Loss of consciousness and neurologic deficits, hearing loss, nausea/vomiting, and comorbid malignancy distinguished abnormal findings from negative imaging findings (AUC 0.729; 95%CI 0.672-0.785; p < 0.001). Patients with unspecific dizziness complaints were less likely to have abnormal imaging findings.

CONCLUSION

These findings highlighted the significance of specific risk factors in recognizing individuals with dizziness complaints who may have abnormal imaging findings indicative of serious diseases. Further studies are warranted to verify the findings.

A Systematic Review of the Reported Proportions of Diagnoses for Dizziness and Vertigo

OBJECTIVES

To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time.

DATA SOURCES

Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016.

STUDY SELECTION

Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics.

DATA EXTRACTION

Data comprising demographics, diagnostic cases, and the total number of cases were recorded and independently tested, followed by a risk of bias analysis.

DATA SYNTHESIS

Sample size weighted proportions expressed as percentages with confidence intervals were calculated and compared using χ analysis and a reference proportion formed by the combination of Ear Nose and Throat and Neurotology case series published between 2010 and 2016. Analysis of diagnostic trends over time used Poisson regression with consideration for overdispersion.

CONCLUSIONS

This systematic review of case series demonstrated significant differences in the proportions of diagnoses for patients presenting with dizziness or vertigo, depending on the specialty making the diagnosis. ENT proportions were dominated by BPPV, Psychogenic and Menière's disease diagnostic categories, whereas emergency proportions were dominated by Other, Cardiac, and Neurological categories. Analysis of case series proportions over time revealed increases in diagnoses such as Benign Paroxysmal Positional Vertigo and Vestibular Migraine, and a corresponding decrease in the diagnoses of Menière's disease.

Association between smoking and the peripheral vestibular disorder: a retrospective cohort study

Common inner ear diseases include peripheral vestibular disorder (PVD) and hearing impairment. The association between smoking and peripheral vestibular disorder (PVD) is unclear. We examined associations between smoking and new PVD events. In this retrospective study, we consecutively enrolled 393 participants aged ≥20 years [mean age 65.3 years; males 133 (33.8%)] treated for hypertension, dyslipidaemia, or diabetes mellitus at a primary care clinic between November 2011 and March 2013. Participants were categorized as ever-smokers (including current and past -smokers; divided per <30 and ≥30 pack-years), and never-smokers. New PVD events were reported over a 1-year follow-up period. Hazard ratios (HR) for new onset PVD were estimated using the Cox proportional hazard regression model. Compared to never-smokers, the adjusted HR was 2.22 for ever-smokers and 2.70 for all ever-smokers with ≥30 pack-years among all 393 participants. Among male participants, compared to never-smokers, the adjusted HR was 4.41 for ever-smokers with ≥30 pack-years. A smoking history of ≥30 pack-years was strongly associated with the risk of new onset PVD in males but not, females. This study may assist patients with smoking cessation for the prevention of new PVD events among males.

Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study

Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events.In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model.The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62-6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75-11.14).Carotid plaques are associated with an increased risk of new PVD events.