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Otolaryngology -- Head and Neck Surgery
http://oto.sagepub.com/content/145/1/110
The online version of this article can be found at:
DOI: 10.1177/0194599811400007
2011 145: 110 originally published online 1 March 2011Otolaryngology -- Head and Neck Surgery
Ying-Ta Lai, Ting-Chuan Wang, Li-Ju Chuang, Ming-Hsu Chen and Pa-Chun Wang
Epidemiology of Vertigo : A National Survey
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Original Research—Otology and Neurotology
Epidemiology of Vertigo: A National
Survey
Otolaryngology–
Head and Neck Surgery
145(1) 110–116
ÓAmerican Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2011
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0194599811400007
http://otojournal.org
Ying-Ta Lai, MD
1
, Ting-Chuan Wang, MHA
2
, Li-Ju Chuang, MHA
3
,
Ming-Hsu Chen, MD
1
, and Pa-Chun Wang, MD, MSc
1,3,4,5
No sponsorships or competing interests have been disclosed for this ar ticle.
Abstract
Objective. To investigate the epidemiology of vertigo among
the general adult population in Taiwan using the National
Health Insurance claims database.
Study Design. Cross-sectional study.
Setting. Data were retrieved from the 2006 National Health
Insurance claims database.
Subjects and Methods. Claims data were retrieved for
patients 18 years or older with a diagnosis of vertigo
(International Classification of Diseases, Ninth Revision,
Clinical Modification codes 078.81, 386.XX, or 780.4) from
January to December 2006. The authors describe the preva-
lence and recurrence of vertigo and the medical resource
utilization associated with its treatment. Logistic regression
models are used to assess the independent effects of age,
sex, seasonal variation, institutional level of care, and spe-
cialty of care on the risk of vertigo recurrence.
Results. A total of 527,807 adult patients (mean 6SD age,
55.1 617.3 years; 1:1.96 ratio of men to women) experi-
enced vertigo in 2006. The prevalence of vertigo was 3.13
cases per 100 adults. Within 1 year of their index vertigo
attack, 199,210 patients (37.7%) experienced recurrence.
The prevalence and recurrence of vertigo increased
significantly with age (P\.001 for both, x
2
test). Age,
sex, seasonal variation, institutional level of care, and spe-
cialty of care had various effects on the risk of vertigo
recurrence.
Conclusion. Vertigo is a major health burden among the gen-
eral adult population and tends to recur, particularly among
older women.
Keywords
vertigo, prevalence, recurrence, risk factor, National Health
Insurance
Received August 17, 2010; revised December 15, 2010; accepted
January 20, 2011.
According to 1995 guidelines by the American
Academy of Otolaryngology—Head and Neck
Surgery, vertigo is characterized as ‘‘the sensation
of motion when no motion is occurring relative to earth’s
gravity.’’
1
Vertigo may arise from the dysfunction of
peripheral or central balance organs. Approximately 80% of
vertigo cases result from peripheral causes, including
Me
´nie
`re’s disease, vestibular neuritis, and benign paroxys-
mal positional vertigo. Central-type vertigo is caused by
more severe diseases, including migrainous vertigo, brain-
stem ischemia, cerebellar infarction, and intracranial hemor-
rhage.
2
Vertigo can disrupt a person’s daily activities and
have a profoundly negative impact on his or her quality of
life.
3,4
Vertigo is common among the general adult population.
To improve clinical care and to allocate medical resources
appropriately, it is important to understand the prevalence
of vertigo. Unfortunately, epidemiological data on vertigo
are limited in the literature. Community health questionnaire
surveys showed that 20% to 30% of the population may
have experienced symptoms of vertigo or dizziness in their
lifetime.
5-7
A national telephone survey in Germany
revealed that the lifetime prevalence of vertigo among
adults is 7.4%, with a 1-year prevalence of 4.9% and a 1-
year incidence of 1.4%; it occurs predominantly among
female and older patients.
4
Based on medical records
review, other retrospective studies
8,9
of patients with vertigo
in the general community reported wide variations in the
prevalence of specific types of vertigo. However, accurate
extrapolation of these study results may be limited by sam-
pling methods and by inconsistent establishment of
diagnoses.
10,11
1
Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
2
Department of Medical Research, Cathay General Hospital, Taipei, Taiwan
3
Cathay Medical Research Institute, Taipei, Taiwan
4
Fu Jen Catholic University School of Medicine, Taipei County, Taiwan
5
Department of Public Health, College of Public Health, China Medical
University, Taichung, Taiwan
Corresponding Author:
Pa-Chun Wang, MD, MSc, Department of Otolaryngology, Cathay General
Hospital, 280, Sec 4, Jen-Ai Rd, 106 Taipei, Taiwan
Email: drtony@seed.net.tw
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Taiwan implemented its universal National Health
Insurance (NHI) program in 1995. The NHI program covers
more than 97% of the population.
12,13
The NHI database
has collected millions of health care claims, which can be
used for health care study. The NHI claims database is man-
aged by Taiwan’s National Healthcare Research Institute
and are available for academic research. The NHI databases
represent useful research sources for epidemiological and
medical utilization studies.
Domestic data on the occurrence of vertigo in Taiwan
are limited. Although claims data from the NHI database
may inaccurately differentiate the nature of vertigo, the
objectives of this study were to investigate the epidemiology
of and risk factors for vertigo in Taiwan using the 2006
NHI claims database. The prevalence and recurrence of ver-
tigo and the medical resource utilization associated with its
treatment are analyzed and reported.
Methods
Data Sources
Data for this study were obtained from the NHI claims data-
base. Claims data from January to December 2006 were
used. The database contains an outpatient health expenditure
file, outpatient order file, admission health expenditure
file, and admission order file. The database uses
diagnostic codes from the International Classification of
Diseases, Ninth Revision, Clinical Modification (ICD-9-
CM). Population data were retrieved from the beneficiary
registry of the Bureau of National Health Insurance.
14
The
study was approved by the institutional review board of
Cathay General Hospital.
Definitions of Terminology
The study used the following inclusion criteria and defini-
tions of terms for data management. Patients 18 years or
older were available for inclusion in the study. Prevalence
was defined as the proportion of the population with existing
disease during a 1-year period. Vertigo was identified by the
presence of ICD-9-CM codes 078.81, 386.XX, or 780.4. The
index attack was defined as the first attack of vertigo occur-
ring in 2006. Visits were defined as the number of outpatient
clinic office visits for a patient. An episode of vertigo com-
prised all office visits with the same diagnosis that occurred
within 28 days. Separate episodes of vertigo had to occur at
least 28 days apart without any vertigo-related visit within
the observed interval. Recurrence was defined as the number
of vertigo episodes following the index attack within at least
12 months’ follow-up.
Study Population
Recruited were adult patients with ICD-9-CM codes 078.81,
386.00 to 386.9 (including 386.0, 386.00, 386.01, 386.02,
386.03, 386.04, 386.1, 386.10, 386.11, 386.12, 386.19,
386.2, 386.3, 386.30, 386.31, 386.32, 386.33, 386.34,
386.35, 386.4, 386.40, 386.41, 386.42, 386.43, 386.48,
386.5, 386.50, 386.51, 386.52, 386.53, 386.54, 386.55,
386.56, 386.58, 386.8, and 386.9), or 780.4. Excluded were
patients with comorbid cerebrovascular diseases (ICD-9-CM
codes 433.00-433.91, 434.00-434.91, 435.8-435.9, 436,
437.8-437.9, or 997.02) that were present at the time of the
index attack.
Statistical Analysis
We used descriptive statistical analyses (frequency, percent-
age, mean, and standard deviation) to describe the preva-
lence, medical resource utilization, and characteristics of the
population with vertigo. We compared prevalence and
recurrence rates using a x
2
test. Continuous variables were
compared using an unpaired ttest or analysis of variance
(ANOVA). We used logistic regression models to assess the
independent effects of age, sex, seasonal variation, institu-
tional level of care, and specialty of care on the prevalence
and recurrence of vertigo. All Pvalues are 2-tailed; P\.05
was considered statistically significant.
Results
General Demographics of Patients with Vertigo
The NHI beneficiary population 18 years or older in Taiwan
comprised 16,838,659 individuals in 2006 (96% of the total
population was covered).
14
A total of 527,807 patients expe-
rienced at least 1 episode of vertigo, with a 1:1.96
(178,192:349,615) ratio of men to women. The mean 6SD
age of the patients was 55.1 617.3 years. There were
931,238 episodes of vertigo, which generated 1,873,040
vertigo-related office visits; 6761 episodes generated 7070
admissions nationwide.
Estimated Prevalence
The 527,807 patients with vertigo accounted for 3.1%
(527,807 of 16,838,659) of the general adult population in
Taiwan. The prevalence of vertigo among the general adult
population was 3.13 cases per 100 adults.
Recurrence
Within 1 year following the index attack, 199,210 patients
(37.7% of all patients with vertigo) had at least 1 recurrence
episode. Among these, 96,215 (48.3%) had 1 recurrence,
42,950 (21.6%) had 2 recurrences, 28,252 (14.2%) had 3
recurrences, and 31,793 (16.0%) had more than 3 recurrences.
Influence of Age
Patients were categorized into the following age groups: 18
to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 years or
older. The prevalence and recurrence of vertigo increased
significantly with age (P\.001 for both, x
2
test; Table 1;
Figure 1).
Influence of Sex
Women comprised 66.2% of the patient population with
vertigo. The prevalence of vertigo was 2.2% among male
adults and 4.0% among female adults. There was female
predominance among all age groups (Figure 1). Recurrence
rates were significantly higher among female patients (P\
.001, x
2
test; Table 1).
Lai et al 111
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Influence of Seasonal Variation
The monthly occurrences of vertigo are shown in Figure 2.
Vertigo was most common in winter (27.1%) and spring
(26.3%). The month with the highest occurrence rate
(12.9%) was January.
Diagnoses
The ICD-9-CM analyses showed that the most commonly used
diagnosis codes for vertigo were 386.1 (other and unspecified
peripheral vertigo), 386.9 (unspecified vertiginous syndromes
and labyrinthine disorders), and 386.0 (Me
´nie
`re’s disease;
38.5%, 25.7%, and 21.6%, respectively). These were followed
by diagnosis codes 386.2 (vertigo of central origin), 386.5 (lab-
yrinthine dysfunction), 386.3 (labyrinthitis), 386.8 (other disor-
ders of labyrinth), and 386.4 (labyrinthine fistula; 10.1%,
3.2%, 0.8%, 0.1%, and 0.01%, respectively).
Medical Resource Utilization
Most vertigo cases were cared for at the primary care clinic
level (817,534 visits [43.6%]), followed by at community
hospitals (789,541 visits [42.2%]) and medical centers
(265,915 visits [14.2%]; Ta b l e 2 ). The patients were treated
by otolaryngologists (452,324 visits [24.1%]), internists
(359,223 visits [19.2%]), neurologists (246,512 visits
[13.2%]), and general practitioners (208,046 visits [11.1%]).
The mean 6SD duration of medication use per episode
was 26.9 628.0 days. The mean 6SD duration of medica-
tion use differed by institutional level of care (19.0 621.5
days in primary care clinics, 32.2 630.7 days in communi-
ty hospitals, and 38.3 631.8 days in medical centers; P\
.001, ANOVA) and by specialty of care (23.6 626.6 days
for internists, 27.6 625.8 days for otolaryngologists,
23.4 626.1 days for general practitioners, and 42.7 632.7
days for neurologists; P\.001, ANOVA).
Episodes required a mean 6SD of 2.0 61.4 visits for
treatment. The number of visits per episode differed by
institutional level of care (1.9 61.5 visits in clinics, 2.1 6
1.4 visits in community hospitals, and 2.1 61.3 visits in
medical centers; P\.001, ANOVA).
Among 7070 vertigo-related admissions, the mean 6SD
length of stay was 5.3 69.6 days (Ta b l e 2 ). Length of stay
differed significantly by institutional level of care (5.0 68.1
days in community hospitals and 6.8 614.3 days in medical
centers; P\.001, ttest) and by specialty of care (5.0 69.0
days for internists, 5.0 63.1 days for otolaryngologists, 4.1
63.3 days for general practitioners, and 4.8 68.3 days for
neurologists; P\.001, ttest). Length of stay also differed
significantly by age group (data not shown).
Table 1. Prevalence and Recurrence of Vertigo
Prevalence
a
Recurrence
Variable No. (%) (n = 527,807) PValue No. (%) (n = 199,210) PValue
Sex \.001 \.001
Male 178,192 (2.2) 67,278 (33.8)
Female 349,615 (4.0) 131,932 (66.2)
Age group, y \.001 \.001
18-29 48,781 (1.2) 8474 (4.3)
30-39 60,034 (1.7) 15,471 (7.8)
40-49 90,591 (2.5) 29,451 (14.8)
50-59 107,023 (4.2) 40,880 (20.5)
60-69 92,597 (6.4) 41,126 (20.6)
70 128,781 (9.2) 63,808 (32.0)
a
Number of patients with vertigo divided by the age (18-29: 4,237,359 / 30-39: 3,609,030 / 40-49: 3,592,698 / 50-59: 2,558,984 / 60-69: 1,441,435 / 70:
1,399,154) and sex (male 8,099,636 / female 8,739,024)-stratified National Health Insurance beneficiary population (total n=16,838,660) times 100%.
0
2
4
6
8
10
12
18-29 30-39 40-49 5 0-59 60-69 ≥70
Male
Female
Figure 1. Age and sex distributions of vertigo.
190000
200000
210000
220000
230000
240000
250000
260000
Spring
(Mar.-May)
Summer
(Jun.-Aug.)
Fall
(Sep.-Nov.)
Winter
(Dec.-Feb.)
Figure 2. Seasonal variation in the occurrence of vertigo.
112 Otolaryngology–Head and Neck Surgery 145(1)
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Risk Factors for Recurrence
Logistic regression models revealed that age, sex, seasonal
variation, institutional level of care, and specialty of care
had various effects on the risk of vertigo recurrence. The
odds of vertigo recurrence were significantly higher among
female patients compared with male patients (odds ratio
[OR] = 1.10; Table 3). Risk of vertigo recurrence increased
significantly with age.
Patients cared for in community hospitals (OR, 0.91) and
in medical centers (OR, 0.89) had significantly decreased
odds of vertigo recurrence (Ta b l e 3 ). Patients cared by neu-
rologists (OR, 1.20), general practitioners (OR, 1.09), oto-
laryngologists (OR, 1.07), and internists (OR, 1.06) had
significantly increased odds of vertigo recurrence.
Patients had significantly decreased odds of vertigo
recurrence when their index attack occurred in summer
(OR, 0.83) or in fall (OR, 0.75; Ta b l e 3 ). Compared with
those whose index attack occurred in spring, patients with
an index attack in winter (OR, 1.60) had significantly
increased odds of vertigo recurrence.
Discussion
Epidemiology of Vertigo
Dizziness, vertigo, and imbalance are commonly reported
by patients. Hannaford et al
7
found that almost 21% of ear,
nose, and throat patients had experienced ‘‘spinning dizzi-
ness’’ in the previous year. In a study of 4 practices in
London, England, Yardley et al
6
noted that dizziness may
account for up to 23.3% of problems reported by patients
(Table 4). However, an accurate prevalence of vertigo
among patients in neurology and otolaryngology clinical
practice is hard to estimate because of difficulty in the dif-
ferential diagnosis.
2
There is limited information on the epi-
demiology of vertigo in general (Table 4), and the data are
difficult to compare because of variability in study
designs.
4,6,15,16
In our claims database study, we estimated
that the prevalence of vertigo in 2006 was 3.13% cases per
100 adults in Taiwan. This is close to the 1-year prevalence
of 4.8% to 5.2% estimated in national telephone question-
naire surveys by Neuhauser et al.
4,16
Recurrence of Vertigo
Recurrence is commonly seen in patients with vertigo.
The natural course of vertigo was evaluated in several
studies.
17-20
Neuhauser et al
4
demonstrated lifelong recur-
rent vestibular vertigo in 89% of patients with the disease.
In a 10-year follow-up study
20
of patients with benign par-
oxysmal positional vertigo, the recurrence rate was 50%;
80% of these recurrences occurred in the first year after the
index attack. Tokumasu et al
18
reported a 51.7% rate of
Me
´nie
`re’s disease recurrence in a 16-year observational
study; 78.6% of recurrences occurred in the first year fol-
lowing the index attack. Tokumasu and colleagues
19
reported that vertigo occurred at a mean frequency of 4.5
episodes per year. In our study, the estimated recurrence
during 1 year after the index vertigo attack was 37.7%;
16.0% of patients with recurrence had more than 3 recurrent
episodes in 1 year. Patients cared for by specialists (otolar-
yngologists, internists, and neurologists) had higher recur-
rence rates, probably attributed to the severity or pattern of
disease.
Risk Factors
Most epidemiological studies on vertigo have dealt with age
and sex. It is generally agreed that vertigo prevalence may
increase with age, especially among women. A cross-
sectional nationwide neurological survey in Germany
showed that the mean age at onset of vertigo was 49.4 years
and that the prevalence was higher among women.
21
Dieterich and Brandt
22
reported that the prevalence rate for
migrainous vertigo was 1.5 times higher among women
compared with men. For Me
´nie
`re’s disease, Watanabe
et al
23
showed that the mean ages at onset were 42 years in
men and 41 years in women. In our study, the data confirm
that prevalence and recurrence of vertigo increase with age,
with a female predominance (Table 3;Figure 1).
Table 2. Medical Resource Utilization for Vertigo
Office Visits Medication Use Length of Stay among Those Admitted
Variable No. (%) PValue Mean 6SD PValue Mean 6SD PValue
Institutional level of care \.001 \.001 \.001
Medical center 265,915 (14.2) 38.3 631.8 6.8 614.3
Community hospital 789,541 (42.1) 32.2 630.7 5.0 68.1
Primary care clinic 817,584 (43.7) 19.0 621.5 —
Specialty of care \.001 \.001 \.001
Internal medicine 359,223 (19.2) 23.6 626.6 5.0 69.0
Otolaryngology 452,324 (24.1) 27.6 625.8 5.0 63.1
Neurology 246,512 (13.2) 42.7 632.7 4.8 68.3
Family medicine 208,046 (11.1) 23.4 626.1 4.1 63.3
Other 606,935 (32.4) 24.5 627.6 7.3 614.4
Total 1,873,040 (100.0) 26.9 628.0 5.3 69.6
Lai et al 113
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Seasonal variation in the occurrence of vertigo is another
notable issue. Wladislavosky-Waserman et al
24
found that
Me
´nie
`re’s disease cases were evenly distributed throughout
the year except for slight increases at the end of winter and
at the beginning of spring. Similar findings were reported by
Mizukoshi et al.
8
Our data are in accord, showing increased
occurrences of vertigo in winter and in spring (Figure 2).
Medical Resource Utilization
Vertigo is one of the most frequently reported problems by
patients in neurology and otolaryngology practices, so an
understanding of the medical resource consumption resulting
from vertigo treatment is important. Neuhauser et al
16
reported that 58% of patients with dizziness had sought at
least 1 medical consultation for the disorder in their lifetime.
Half of these patients were seen by primary care physicians
and the other half by neurologists or otolaryngologists. Our
data show that most patients with vertigo were cared for by
otolaryngologists, internists, or neurologists at the primary
care level (Ta b l e 2 ). Our 1.2% admission rate (6311 of
527,807 patients with vertigo) in Taiwan was less than the
1.9% admission rate reported by Neuhauser et al.
16
It is notable that recurrence rates were lower among
patients treated in community hospitals and medical centers.
We speculate that this may be attributable to longer medica-
tion regimens prescribed by these institutions (Table 2).
Methodological and Study Limitations
The NHI database is a useful data source to provide epide-
miological information on vertigo. However, the data set
contains no clinical or disease severity information. The
accuracy of diagnosis coding by health care providers may
affect the validity of the data, although the Bureau of
National Health Insurance has adopted several measures to
cross-check and monitor the accuracy of diagnostic coding.
We found that most providers were unable to accurately dif-
ferentiate an actual diagnosis of vertigo at the index visit.
The prevalence of Me
´nie
`re’s disease, benign paroxysmal
positional vertigo, or vestibular neuritis cannot be estimated
from our study findings. The data set we used is a claims
database. To convert claims data to epidemiological infor-
mation, we made some assumptions in conducting data
management. Under Taiwan’s NHI regulations, patients
may obtain a prescription covering 1 to 28 days during an
office visit; we arbitrarily defined all visits occurring within
28 days as follow-up visits for that episode of disease. This
may have resulted in underestimation of the actual preva-
lence and recurrence of vertigo.
Table 3. Logistic Regression Analysis for Predictors of Vertigo Recurrence
Variable Coefficient (b) Standard Error Wald x
2
Odds Ratio (95% Confidence Interval) PValue
Sex
Male — — — — —
Female 0.09 0.006 211.59 1.10 (1.08-1.11) \.001
Age group, y
18-29 — — — — —
30-39 0.49 0.015 1035.52 1.64 (1.59-1.69) \.001
40-49 0.81 0.014 3313.84 2.24 (2.18-2.30) \.001
50-59 1.05 0.014 5970.35 2.87 (2.79-2.94) \.001
60-69 1.30 0.014 8836.86 3.66 (3.56-3.76) \.001
70 1.50 0.013 12,639.41 4.49 (4.37-4.61) \.001
Institutional level of care
Medical center 20.12 0.010 148.11 0.89 (0.87-0.90) \.001
Community hospital 20.09 0.007 189.16 0.91 (0.90-0.92) \.001
Primary care clinic 20.19 — — — —
Specialty of care
Internal medicine 0.06 0.009 42.25 1.06 (1.04-1.08) \.001
Otolaryngology 0.06 0.008 64.13 1.07 (1.05-1.08) \.001
Neurology 0.18 0.011 274.33 1.20 (1.18-1.23) \.001
Family medicine 0.08 0.010 63.72 1.09 (1.06-1.11) \.001
Other — — — — —
Season of vertigo occurrence
Spring — — — — —
Summer 20.19 0.009 463.69 0.83 (0.81-0.84) \.001
Fall 20.28 0.009 1006.14 0.75 (0.74-0.77) \.001
Winter 0.47 0.008 3840.81 1.60 (1.58-1.63) \.001
114 Otolaryngology–Head and Neck Surgery 145(1)
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Conclusion
Limited epidemiological data on vertigo are available in the
literature. In this study, we found that vertigo is a major
health burden among the general adult population. During
2006 in Taiwan, 527,807 adults sought health care services
because of vertigo, representing an annual prevalence of
3.13 cases per 100 adults; the overall recurrence rate within
1 year of the index attack was 37.7%. Older women experi-
enced the highest recurrence of vertigo.
Acknowledgment
This study is based in part on data from the National Health
Insurance research database provided by the Bureau of National
Health Insurance, Department of Health, and managed by the
National Health Research Institutes. The interpretation and conclu-
sions herein do not necessarily represent those of the Bureau of
National Health Insurance, Department of Health, or the National
Health Research Institutes of Taiwan, Republic of China.
Author Contributions
Ying-Ta Lai, drafting the article or revising it critically for impor-
tant intellectual content; Ting-Chuan Wang, analysis and interpre-
tation of data; Li-Ju Chuang, drafting the article or revising it
critically for important intellectual content; Ming-Hsu Chen, anal-
ysis and interpretation of data; Pa-Chun Wang, corresponding
author, manuscript editing and finalization.
Disclosures
Competing interests: None.
Sponsorships: None.
Funding source: None.
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Table 4. Literature on the Epidemiology of Vertigo
Source Disease Entity Methods Study Population Findings
Yardley et al,
6
1998
Dizziness Postal questionnaires 2064 people (aged 18-64 y)
randomly sampled from the
patient lists of 4 London
practices
23.3% reported symptoms of
dizziness in past month
Guilemany
et al,
15
2004
Vertigo Prospective study,
medical report
3283 patients treated at ENT
service of the Hospital Clinic
in Barcelona
18% (591/3283) experienced
vertigo between January 1,
2001, and December 31, 2001
Neuhauser
et al,
4
2005
Vestibular vertigo,
dizziness, imbalance
Cross-sectional
neurotologic survey,
computer-assisted
telephone interviews
Noninstitutionalized adult
population in Germany
Nationwide modified random-
digit dial sampling
Lifetime prevalence of vestibular
vertigo: 7.8%, 1-y prevalence:
5.2%,1-y incidence: 1.5%
Vestibular vertigo affects .5%
of adults in 1 y
Neuhauser
et al,
16
2008
Dizziness, vertigo Cross-sectional
neurotologic survey,
computer-assisted
telephone interviews
Noninstitutionalized adult
population in Germany
Nationwide modified random-
digit dial sampling
Vestibular vertigo prevalence:
4.8%
Vestibular vertigo incidence:
1.4%
Lai et al 115
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