Referral and final diagnoses of patients assessed in an academic vertigo center

Abstract

Objective: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient.

Materials and methods: Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65 years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses.

Results: Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (<65 year from 12.7 to 25.1%) and older patients (from 20.7 to 37.6%). Striking relative increases were found for the diagnoses multisensory dizziness in older patients (from 20.7 to 37.6%) and vestibular migraine in younger patients (1.8 to 20.2%). In both age groups, the proportion of patients with undetermined diagnoses was reduced by about 60% (younger: 69.8 to 9.8%; older: 69.2 to 12.4%) by the diagnostic procedures in the vertigo center. These changes were all significant (p < 0.05) in McNemar tests with continuity correction (2 × 2 tables: focused diagnosis vs. other diagnoses, referral vs. final).

Conclusion: Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.

Keywords: benign paroxysmal positional vertigo; diagnostic impact; dizziness; multisensory dizziness; neuro-otology; vertigo; vestibular migraine.

Figure 1

Distribution of referral and final diagnoses in all patients. “Others” include presyncopal dizziness, perilymph fistula, ocular vertigo, afferent ataxia, dizziness after head trauma, vestibular paroxysmia, acoustic neuroma, canal dehiscence syndrome, mal de débarquement, ototoxicity, dizziness after cervical spine distorsion, vertigo in cervical pain syndrome.

Figure 2

Distribution of referral and final diagnoses in patients under the age of 65 years. “Others” include presyncopal dizziness, perilymph fistula, ocular vertigo, afferent ataxia, and dizziness after head trauma, vestibular paroxysmia, acoustic neuroma, canal dehiscence syndrome, mal de débarquement, ototoxicity, dizziness after cervical spine distorsion, vertigo in cervical pain syndrome.

Figure 3

Distribution of referral and final diagnoses in patients aged 65 years and above. “Others” include presyncopal dizziness, perilymph fistula, ocular vertigo, afferent ataxia, dizziness after head trauma, vestibular paroxysmia, acoustic neuroma, canal dehiscence syndrome, mal de débarquement, ototoxicity, dizziness after cervical spine distorsion, vertigo in cervical pain syndrome.