The Impact of Coronavirus Disease 2019 Epidemic on Dizziness/Vertigo Outpatients in a Neurological Clinic in China

Epidemiology of patients with dizziness over a 3-year period, requiring utilization of the emergency medical serviced system: A pre- and post-COVID pandemic comparative study using the population-based ORION registry

OBJECTIVE

We aimed to identify the proportion of each medical condition or disease contributing to dizziness and their disposition in the Emergency Department (ED).

METHODS

This retrospective, descriptive study examined data from the Osaka Emergency Information Research Intelligent Operation Network system in Japan for the period from January 1, 2018 to December 31, 2020. The inclusion criteria were patients with presumptive ICD-10 codes including "dizziness" or "vertigo". Patient demographics were compared using the χ2 test and Kruskal-Wallis test. Logistic regression analysis was performed to calculate disposition from ED (emergency admission or discharge) over the 3-year study period. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariate analyses.

RESULTS

During the 3-year study period, a total of 1,346,457 patients (462,773 in 2018, 468,697 in 2019, and 414,987 in 2020; P < 0.001), including 53,190 patients with dizziness (18,396 in 2018, 18,649 in 2019, and 16,145 in 2020; P = 0.058), were identified as having been transported to hospitals by ambulance in Osaka Prefecture. Dizziness and giddiness (R42) was the most common form of dizziness, in 27,075 cases (9,570 in 2018, 9,613 in 2019, and 7,892 in 2020; P < 0.001; Gender composition showed 10,483 males and 16,592 females.) Vestibular Neuronitis (H81.2) showed significant increase in 2020 compared to the two preceding years (91 in 2018, 119 in 2019, and 130 in 2020, P = 0.003; including 174 males and 167 females, respectively). Of the 53,190 patients with dizziness, 11,862 (22.3%; 4,323 males, 7,539 females) were admitted to hospital. The odds ratio (OR) for emergency admission for dizziness in 2020 during the COVID-19 pandemic was 0.98 (95% confidence interval (CI), 0.93- 1.03) with reference to 2018.

CONCLUSION

Patients with dizziness accounted approximately 4% of ED transportations, with about 20% requiring hospital admission, irrespective of the COVID-19 pandemic. Vestibular neuronitis was significantly increased in 2020.

Living with a vestibular disorder during the Covid-19 pandemic: An online survey study

BACKGROUND

People with vestibular disorders experience symptoms which put them at risk of reduced wellbeing during the Covid-19 pandemic.

OBJECTIVE

To assess the impact of the Covid-19 pandemic on vestibular symptoms, access to healthcare and daily activities amongst people living with a vestibular disorder.

METHODS

An online survey was completed by 124 people in the UK with a vestibular disorder. The survey incorporated the Vertigo Symptom Scale-Short Form and questions regarding health status, healthcare received, daily activities and employment during Covid-19.

RESULTS

The Covid-19 pandemic affected perceptions of wellbeing. 54.1% rated their health as worse now than before the pandemic. Vertigo, unsteadiness, dizziness, tinnitus, loss of concentration/memory, and headaches were the most exacerbated symptoms. Respondents reported changes to their daily activities including reduced social contact (83%) and exercise (54.3%). Some experienced healthcare delays or received a remote appointment. Remote care was perceived as convenient, but barriers included difficulty communicating, trouble concentrating and perceived unsuitability for initial appointments. Unintended benefits of the pandemic included less social pressure, avoiding busy environments, and engaging in self-care.

CONCLUSION

The effects of the Covid-19 pandemic are diverse. Clinical services should be mindful that Covid-19 can exacerbate vestibular and allied neuropsychiatric symptoms that require acute, multi-disciplinary intervention, but not lose sight of the potential benefit and cost saving associated with promoting self-management and delivering remote care, especially post-diagnosis.

Change in Diagnosis of Benign Paroxysmal Positional Vertigo During COVID-19 Pandemic

Purpose

The present study investigated the impact of coronavirus disease 2019 (COVID-19) pandemic on benign paroxysmal positional vertigo (BPPV).

Patients and Methods

The medical records of BPPV patients who were evaluated in the outpatient department (OPD) and emergency room (ER) during (435 patients) and before (517 patients) the COVID-19 pandemic were retrospectively reviewed. Dix-Hallpike and supine head-roll tests were used to classify the subtype of BPPV as posterior semicircular canal (PSCC), geotropic lateral semicircular canal (geotropic LSCC), or apogeotropic lateral semicircular canal (apogeotropic LSCC) BPPV.

Results

More patients with PSCC BPPV were diagnosed at the OPD compared with those who were diagnosed at the ER both before and during the COVID-19 pandemic; however, more patients with LSCC BPPV were diagnosed at the ER compared with those who were diagnosed at the OPD during the same periods. The mean time interval between vertigo onset and initial evaluation was remarkably longer during the pandemic in patients with PSCC BPPV.

Conclusion

This study demonstrated that the incidences of BPPV subtypes according to hospital visit type were not significantly different before and during the COVID-19 pandemic. Because hospital visits were delayed in patients with PSCC BPPV during the COVID-19 pandemic, telemedicine or e-health could be suitable alternatives to face-to-face medical care for these patients.