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Epidemiology of Vertigo: A National Survey

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To investigate the epidemiology of vertigo among the general adult population in Taiwan using the National Health Insurance claims database. Cross-sectional study. 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 prevalence 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 specialty of care on the risk of vertigo recurrence. A total of 527,807 adult patients (mean ± SD age, 55.1 ± 17.3 years; 1:1.96 ratio of men to women) experienced 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, x² test). Age, sex, seasonal variation, institutional level of care, and specialty of care had various effects on the risk of vertigo recurrence. Vertigo is a major health burden among the general adult population and tends to recur, particularly among older women
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Otolaryngology -- Head and Neck Surgery
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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
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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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... Similarly, many previous studies contradict our results [16,22,[25][26][27][28]. Because smoking is considered a risk factor for vertigo [29], the association of smoking with vertigo has been investigated. ...
... Most smokers suffering from vertigo were young; however, more than 30% of vertigo occurred in old age [14]. Also, male smokers were suffering from vertigo more than females; however, most vertigo researchers found females to be usually more affected than males [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. This is an interesting finding; due to our limitations, we need more studies to focus on this difference and explain the cause of it. ...
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Background Smoking is widespread at all ages in Saudi society. In addition, complaints of vertigo are common. A key problem is how smoking affects vertigo and, thus, quality of life. Researchers have investigated the association between smoking and vertigo and found that smoking may be a risk factor for vertigo, but this association is not clear. The current study aims to investigate the association between smoking and vertigo. Materials and methods We conducted a cross-sectional study from March 2022 to January 2023 to investigate the effect of smoking on vertigo in Saudi Arabia’s adult population. Results We found that smokers were more prone to vertigo than non-smokers. In addition, the severity of vertigo increases as the number of cigarettes smoked or the length of time in years that the person has smoked increases. Conclusion The findings of the study should inspire more research into the impact of demographic factors on vertigo among smokers.
... Vertigo is the most frequent category of dizziness across age groups (6,19), although its prevalence may increase with age (8,20). Murdin and Schilder (8) reported that the prevalence of vertigo ranges from 3 to 10%. ...
... Overall, the distribution of risk factors for dizziness may account for the differences in prevalence among groups. The highest prevalence of vertigo was observed in participants aged 18-25 years and decreased with increasing age; this finding is consistent with those of some previous studies (18,19) and inconsistent with those of others (8,20). Vertigo has been reported in 20.8% of adolescents aged 12-19 years, suggesting this population may be affected by peripheral dizziness (1). ...
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Introduction Dizziness is one of the most common and recurring complaints in adults presenting at the clinic. However, its prevalence in the population of the Kingdom of Saudi Arabia remains unclear. We aimed to examine the prevalence and correlates of dizziness in a large sample of the Saudi population. Methods In this is cross-sectional study, we used an electronic survey, which was completed by 1.478 respondents, with a response rate of 84% across five regions of Saudi Arabia. The online survey was launched on the Qualtrics website and distributed via social media channels to obtain heterogeneous responses. The study included adults aged ≥18 years who resided in Saudi Arabia during data collection. We used t-test and chi-square test for descriptive analysis and multiple logistic regression model to assess prevalence and predictors of dizziness. Results More than half of the participants were aged between 26 years and 45 years (58.66%). Of the participants, 42.97% reported having dizziness at the time of taking the survey. Women were less likely than men to report dizziness (OR = 0.65; CI, 0.49, 0.87; p = 0.003). A description of the type of dizziness by age revealed that vertigo slightly decreased with age. Unclear vision with movement or blurry vision was common in young adults, whereas imbalance was common in older adults. A multiple regression model adjusted for demographic characteristics revealed a statistically significant association between dizziness and age group. Participants in the age group of 46–55 years were 1.83 times more likely to report dizziness compared to those aged >65 years (odds ratio = 1.83; confidence interval, 0.62, 5.41; p = 0.0009). Discussion Dizziness is a common complaint in Saudi Arabia. Future studies should elucidate the risk factors for and mechanisms of dizziness to help prevent falls and reduced quality of life.
... Predictors of dizziness in the general population include female sex, high age, and low education [5,13,[29][30][31]. The current study, when stratified for gender, age and ICD-10 category, did not fully confirm previous studies as the risk for sick leave due to nonspecific and vestibular dizziness/vertigo appeared unrelated to age among highly educated women. ...
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Background Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific “R” diagnoses. Methods Through Swedish nationwide registers we identified individuals aged 16–64 years who during the years 2005–2018 were sickness absent > 14 consecutive days – minimum register threshold – due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. Results We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005–2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21–61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). Conclusions The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.
... Our finding showed that the total annual number of diseases of the inner ear hospital admissions for various causes increased by 234.8% from 5704 in 1999 to 19 Taiwan, while a higher documented estimated prevalence rate (5.0%) was reported three years later [18,19]. Indeed, laboratory testing for inner ear disorders has improved in recent years, and consequently, vestibular apparatus examination has become feasible, and vestibular disorders, therefore, can be diagnosed more frequently [20]. ...
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Background: Due to an expansion in the usage of medications (such as anticancer therapies), increased exposure to noise, and an increase in life expectancy, the prevalence of inner ear disease-related hearing loss is rising. Diseases of the inner ear are frequently accompanied by other conditions, such as chronic heart failure, systemic inflammation, arterial hypertension, and cerebrovascular disease. The aim of this study was to investigate the profile of hospital admissions linked to inner ear diseases in England and Wales. Method: This was an ecological descriptive study using public medical databases in England and Wales. Diagnostic codes for diseases of the inner ear (H80-H83) were used to identify all hospital admissions. Between 1999 and 2020, the chi-squared test was used to assess the difference between the admission rates. Results: From 5704 in 1999 to 19,097 in 2020, the total annual number of hospital admissions increased by 234.8%, which corresponds to a 192.3% increase in the admission rate [from 10.94 (95% CI 10.66-11.22) in 1999 to 31.98 (95% CI 31.52-32.43) in 2020 per 100,000 people, p < 0.01]. "Disorders of vestibular function" and "other inner ear diseases" were the most frequent causes of hospital admissions due to inner ear diseases, accounting for 47.6% and 43.6%, respectively. The age range of 15 to 59 years accounted for 42.3% of all diseases of the inner ear hospital admissions. Around 59.6% of all admissions were made by females. The female admission rate increased by 210.1% (from 12.43 (95% CI 12.01-12.85) in 1999 to 38.54 (95% CI 37.84-39.24) in 2020 per 100,000 people). The male admission rate for diseases of the inner ear increased by 169.6% [from 9.37 (95% CI 9.00-9.75) in 1999 to 25.26 (95% CI 24.69-25.84) per 100,000 people] in 2020. Conclusion: Inner ear disease admissions increased markedly in England and Wales during the past two decades. Females and the middle-aged population were at higher risk of being admitted for inner ear diseases. Further cohort studies are warranted to identify other risk factors and develop effective prevention strategies.
Article
Objective To evaluate diagnostic trends in pediatric and adult patients presenting for multidisciplinary subspecialty evaluation of dizziness and imbalance across the lifespan. Study Design Retrospective chart review. Setting Single pediatric and single adult academic tertiary care hospital. Methods Retrospective review of electronic health record for patients presenting to an adult or pediatric multidisciplinary vestibular clinic from 2017 to 2020, including clinical data, physical therapy evaluation, and audiovestibular testing. Results A total of 1934 patients aged 1 to 95 were evaluated. Most patients were female (n = 1188, 61%); the largest cohort was in the fifth decade of life (n = 321, 17%). Seventy‐six percent of patients (n = 1470) were assigned a pathologic diagnosis. Central causes of dizziness were most common in children and young adults, comprising 38% to 54% of all diagnoses in ages 1 to 30. The proportion of peripheral vestibular disorders increased with age, peaking at 32% in ages 61 to 70. Vestibular migraine was the most common pathologic diagnosis in ages 6 to 20 (n = 110, 39%) and 31 and 50 (n = 69, 17%) regardless of gender, but was more prevalent in females (21% vs 14%; P < .0001). The prevalence of benign paroxysmal positional vertigo (BPPV) increased throughout the lifespan, peaking at age 71 to 80. Meniere's disease (MD) did not occur within the first decade of life, but increased thereafter, peaking at ages 51 to 60. Conclusion Multidisciplinary vestibular evaluation resulted in a diagnosis for the majority of patients. Vestibular diagnoses vary across the lifespan however among most age groups, central disorders, including migraine disorders, outnumber peripheral vestibulopathies. The prevalence of peripheral vestibular disorders such as BPPV and MD increased with age. Level of Evidence Level IV.
Article
Objectives: Recent studies have suggested that older adults with hearing loss (HL) are at a greater risk of postural instability than those with normal hearing. However, little is known regarding this association in middle-aged individuals. The relationships between HL laterality, asymmetric hearing, and posture control are similarly unclear. The purpose of this study was to investigate the effects of hearing status on postural control and to explore the dose-response relationship between the hearing threshold and postural instability risk in middle-aged adults. Design: This cross-sectional study included 1308 participants aged 40 to 69 years with complete audiometric and standing balance function data from the 2001-2004 National Health and Nutrition Examination Survey. Speech-frequency HL was defined as a pure-tone average at 0.5, 1, 2, and 4 kHz of >25 dB in the better-hearing ear; high-frequency HL was defined as a pure-tone average at 3, 4, and 6 kHz of >25 dB. Asymmetric hearing was defined as a difference in the pure-tone average >15 dB between ears. Postural instability was defined as participants ending the modified Romberg test in condition 4. Results: After adjustment for sociodemographic variables, lifestyle, and comorbidities, speech-frequency HL, except for unilateral HL, was associated with increased postural instability (mild HL: odds ratio [OR], 2.33; 95% confidence interval [CI], 1.25-4.35; moderate-to-severe HL: OR, 3.59; 95% CI, 1.61-8.03). Compared with individuals with normal bilateral hearing, participants with bilateral HL also showed a higher risk of postural instability (OR, 2.88; 95% CI, 1.61-5.14). The OR for postural instability among participants with asymmetric hearing compared with those with symmetric hearing was 2.75 (95% CI, 1.37-5.52). Furthermore, each 10 dB increase in the speech-frequency hearing threshold was associated with a 44% higher risk of postural instability. Conclusions: Hearing loss is associated with poorer postural control. Individuals with asymmetric hearing have a higher postural instability risk compared with those with symmetric hearing. Further studies are needed to confirm these findings and the causality. Moreover, future studies are warranted to assess whether hearing aids are beneficial for the restoration of impaired balance functions.
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Purpose To determine the internal consistency and reliability of the “Questionário de Impacto Emocional da Vertigem (CIEV)” and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders. Methods 38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach’s alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson’s correlation test, respectively. Results There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson’s correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788). Conclusion The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders. Keywords: Dizziness; Vertigo; Symptom Assessment; Emotional Distress; Questionnaires
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Benign paroxysmal positional vertigo (BPPV) is the most common diagnosis for peripheral vertigo. Although pathophysiological mechanisms remain unclear, BPPV is mostly idiopathic and factors related to BPPV are still being investigated. Knowing these factors can contribute to the prevention and management of BPPV. In this study, we investigated the correlations between climatic variations, pollution, and BPPV retrospectively. 262 patients diagnosed with BPPV between 2019 and 2021 in Kars, Türkiye, were included in our study. Meteorological parameters were obtained from Turkish State Meteorological Service. Horizontal BPPV increased significantly with the humidity (p < 0.05). In addition, carbon monoxide levels significantly increased the potantial of BPPV (p < 0.05). Surprisingly, BPPV increased in the summertime and showed a significant relationship with humidity. We believe this change is related with the city-specific features as it is the coldest place in the country, emigrant province and crowded in the summer times.
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Background: While physical symptoms are the leading reason for outpatient visits, a substantial proportion of physical complaints and "minor" illnesses remain poorly understood. The purpose of our study was to determine the prevalence, patient-attributed cause, and psychiatric comorbidity of symptoms in a general population.Methods: We analyzed data on 13 538 individuals interviewed in the Epidemiologic Catchment Area Program, a multicommunity mental health survey that used the Diagnostic Interview Schedule to determine the prevalence of psychiatric disorders. The Diagnostic Interview Schedule inquires about 38 physical symptoms and includes a probing scheme to classify symptom severity and potential cause. We focused on 26 symptoms most germane to primary care.Results: Of the 26 symptoms, 24 had been problems for more than 10% of persons at some point in their life, with the most common nonmenstrual symptoms being joint pains (36.7%), back pain (31.5%), headaches (24.9%), chest pain (24.6%), arm or leg pain (24.3%), abdominal pain (23.6%), fatigue (23.6%), and dizziness (23.2%). Most symptoms (84%) were at some point considered major in that they interfered with routine activities or had led individuals to take medications or visit a physician. Nearly one third of symptoms were either psychiatric or unexplained, and most symptoms were associated with at least a twofold increased lifetime risk of a common psychiatric disorder.Conclusion: Symptoms in the community are prevalent as well as bothersome. Often lacking an apparent physical explanation, such symptoms are associated with an increased likelihood of psychiatric disorders.(Arch Intern Med. 1993;153:2474-2480)
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To evaluate the frequency and duration of episodes of definitive vertigo in Ménière's disease. Prospective longitudinal study. Multiple tertiary referral centers. Five hundred ten individuals from 8 hospitals that met the American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria for definitive Ménière's disease. Conservative treatment. Frequency and duration of episodes of definitive vertigo during follow-up. Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life. The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than 6 hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease. The percentage of patients without episodes of vertigo increases as the disease progresses, and 70% of patients who did not have an episode of vertigo for 1 year will continue to be free of episodes during the following year. Thus, there is a relationship between the frequency of episodes in consecutive years, although this association decreases rapidly as the number of years increases. The frequency of definitive episodes of vertigo in Ménière's disease decreased during follow-up, and many individuals reached a steady-state phase free of vertigo.
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One hundred eighty cases of Meniere's disease were identified in the Rochester, MN population during the 30-year period, 1951 through 1980. The annual age-adjusted incidence rate per 100,000 population was 15.3; the preponderance for females (16.3) over males (13.3) was not statistically significant. There was no change in annual incidence rate from 1951 through 1970, and a slight decrease in the period, 1971 through 1980. The prevalence rate on January 1,1980, was 218.2 per 100,000 population. Clinical aspects of Meniere's disease noted during the course of this study are reported.
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Dizziness and vertigo are common, however, the cause often remains unexplained. The percentage of vertigo of vestibular origin in individuals with unselected dizziness has not been well examined, and its underestimation may lead to diagnostic bias in primary care. The purpose of this study was to reassess the burden of dizziness in the community and to quantify the contribution of vertigo of vestibular origin. A nationally representative sample of 4869 adults living in Germany was screened for moderate or severe dizziness, and 1003 individuals with dizziness underwent validated neurotologic interviews to differentiate vestibular vertigo from nonvestibular dizziness according to explicit diagnostic criteria. Dizziness/vertigo had a prevalence of 22.9% in the last 12 months and an incidence (first episode of dizziness/vertigo) of 3.1%. For vestibular vertigo, the prevalence was 4.9% [corrected] and the incidence was 1.4%. We also found that 1.8% of unselected adults consulted a physician in the last 12 months for [corrected] dizziness/vertigo (0.9% for vestibular vertigo). 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). However, more than half of the participants with vestibular vertigo reported nonvestibular diagnoses. Age- and sex-adjusted health-related quality of life was lower in individuals with dizziness and vertigo compared with dizziness-free control subjects. The occurrence of dizziness and vertigo is frequent and associated with a considerable personal and health care burden. Vestibular vertigo accounts for a considerable percentage of this burden, which suggests that diagnosis and treatment of frequent vestibular conditions are important issues in primary care.
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A retrospective review of our population-based medical records linkage system for residents of Olmsted County, Minnesota, revealed 53 patients (34 women and 19 men; mean age, 51 years) with newly diagnosed benign positional vertigo in 1984. The age- and sex-adjusted incidence was 64 per 100,000 population per year (95% confidence interval, 46 to 81 per 100,000). The incidence of benign positional vertigo increased by 38% with each decade of life (95% confidence interval, 23 to 54%). One patient had an initial stroke during follow-up; thus, the relative risk for new stroke associated with benign positional vertigo was 1.62 (95% confidence interval, 0.04 to 8.98) in comparison with the expected occurrence based on incidence rates for an age- and sex-adjusted control population. The observed survival among the 53 Olmsted County residents with benign positional vertigo diagnosed in 1984 was not significantly different from that of an age- and sex-matched general population. Patients with benign positional vertigo seem to have a good prognosis.
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In 1980, the Research Committee of Peripheral Vestibular Disorders in Japan, which is supported by the Ministry of Health and Welfare, was founded by 24 members, from several districts in Japan. The Committee's first task was to draft the diagnostic criteria for several peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis. For the national epidemiological survey, they then collected the data on 101 cases of BPPV out of some 783 vestibular disorder patients. In addition, data on 103 patients of BPPV out of 559 vestibular disorder patients were also collected from the Neuro-otological Clinic of the Toyama Medical and Pharmaceutical University Hospital. From these epidemiological surveys, the incidence of BPPV in Japan was estimated at 10.7 per 100,000 population, while that of BPPV in Toyama was estimated at 17.3 per 100,000 population. The ratio of BPPV was higher in female than male patients in both surveys. The age at the onset of BPPV peaked in the fourth decade in both males and females. Compared with the other epidemiological features of Meniere's disease and sudden deafness with vertigo in the same surveys, it appeared that the characteristic features of BPPV are epidemiologically similar to those of Meniere's disease, but different from those of sudden deafness.
Article
One hundred eighty cases of Meniere's disease were identified in the Rochester, MN population during the 30-year period, 1951 through 1980. The annual age-adjusted incidence rate per 100,000 population was 15.3; the preponderance for females (16.3) over males (13.3) was not statistically significant. There was no change in annual incidence rate from 1951 through 1970, and a slight decrease in the period, 1971 through 1980. The prevalence rate on January 1, 1980, was 218.2 per 100,000 population. Clinical aspects of Meniere's disease noted during the course of this study are reported.
Article
The incidence of Menière's disease was investigated in a total of 3222 patients with vertigo or dizziness who had visited Kitasato University Hospital during 1985-1991. Two hundred and fifty-one of the cases (7.8%) were found to suffer from Menière's disease and the male:female ratio was 1:1. Seventy cases of Menière's disease with complete records were classified into five groups, depending on the duration of the illness since its onset. Both ears were affected in 12 (17.1%) of the patients but in 4 (33.3%) of prolonged 12 patients having more than 15 years after the onset. All 70 patients had been treated conservatively, except for 3 who had undergone surgery. Frequency of vertiginous attacks and hearing impairment during the last year in each group were retrospectively compared with those of the other groups. No vertiginous attacks were experienced in 13 (24.1%) cases. The average number of vertigo attacks during the last year was 4.5 per year in 49 cases. Adequate therapy is desirable within one year after the onset of Menière's disease: the results showed the frequency of vertiginous attacks to be lowest and hearing levels to be best in the first group who were treated less than one year after the onset, in comparison with the other prolonged cases.
Article
From 1975 to 1990, nationwide surveys on Menière's disease were performed three times by the Research Committee of Menière's disease (1975-76) and the Research Committee of Peripheral Vestibular Disorders (1982-84 and 1990) in Japan. Nine hundred and fifty-eight definite Menière cases, 520 in the 1st, 230 in the 2nd and 148 in the 3rd survey, were sampled by the members of the Committees. The epidemiological and clinical characteristics of Menière's disease were analyzed and compared with such control cases as other vertiginous patients, ENT patients without vertigo, and healthy subjects. In Menière's disease, the male to female ratio has changed from even to female predominance over the 15 years the study ran. The age distribution at onset peaked in the forties for males and thirties for females. Significant epidemiological results are summarized as follows: Definite Menière's disease has a higher incidence in married persons and in people with a nervous and precise character, whereas the incidence is lower in obese people. Physical and mental fatigue induced the onset of attacks. Menière's disease happened in day time in many cases, especially during the afternoon. As these epidemiological findings were commonly observed in all the surveys, the results are considered to be universal epidemiological characteristics of Menière's disease in Japan. In the same period, regional investigations were performed by Toyama Medical Association and our University. The male to female ratio in Toyama indicated a more significant female predominance than in the nationwide surveys. The prevalence of Menière's disease in Toyama Prefecture has been almost constant in all surveys, about 17/100,000 since 1974.(ABSTRACT TRUNCATED AT 250 WORDS)