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May 15, 2014

Top 4 Causes of Dizziness (Table)

Dizziness is an extremely common disorder that afflicts an estimated 10-20% of individuals older than 70 years old. Even for those younger, dizziness is a not uncommon problem.

Several studies have been performed over the years to try and quantitate what are the most common causes of dizziness to help narrow the possibilities given the workup for dizziness can be long, tedious, and time-consuming which often frustrates patients.

Also frustrating is the fact that without a diagnosis, treatment can not be reliably pursued resulting in symptom persistence in spite of attempted treatment.

In any case, in rank order, the top 4 most common causes of dizziness are:

#1: BPPV

Depending on the study (see table below), accounts for ~25% of all dizziness. The symptoms of BPPV (Benign Paroxysmal Positional Vertigo) are spinning attacks that last no more than a few minutes that occur with positional changes, usually turning the head. Diagnosis is achieved by Dix-Hallpike maneuver. Treatment is positional therapy, usually Epley.

#2: Anxiety

Frequency is around 20% depending on the study (see table below). Fairly self-explanatory. Usually the dizziness is described as light-headed imbalance that lasts hours to days.


#3: Unknown

In spite of exhaustive testing and evaluation by multiple specialties, a diagnosis is never reached and treatment is symptomatic. Sadly, the cause of the dizziness can not be found in approximately 20% of patients.

#4: Orthostatic Hypotension

Orthostatic hypotension is usually described as light-headedness (vision going dark when severe) when going from a laying to standing position. Due to cardiac or blood pressure issues which when corrected, resolves this particular dizziness. Only around 5% is dizziness attributable to this condition.

Below is a table (references at end) that goes over the frequency rates for other causes of dizziness.

Variable
Study #1 Study #2 Study #3 Study #4 Study #5
# of Patients
1194
117
149
731
2556
Age of Subjects
over 70
over 50
over 65
over 70
under 70
Examiner
ENT
Neurology
Geriatrics
ENT
Neurology
ENT
Neurology
Diagnosis
BPPV
47%
26%
4%
27.6%
22.6%
Anxiety
0%
3%
32%
15.3%
33%
No Diagnosis
23%
14%
0%
15.2%
11.4%
Orthostatic Hypotension
2%
3%
1%
7.1%
1.3%
Vascular Disorder
8%
7%
70%
5.2%
0.2%
Cervical Disorder
0%
0%
66%
0%
0%
Meniere's Disease
4.05%
4%
-
5.2%
5.6%
Migraine
0.08%
-
-
1.1%
3.9%
Labyrinthitis
1.77%
3%
-
0.96%
0.51%
Brain Tumor
1.4%
3%
-
0.55%
0.24%
Medication Side Effect
-
2%
-
1.9%
0.2%
Stroke/TIA
6.34%
7%
-
5.2%
0.2%


References:
Dizziness in the elderly: Diagnosing its causes in a multidisciplinary dizziness unit. ENT Journal. 93(4-5):162-167.

Dizziness in elderly men. JAGS 42:1184-1188.

Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 313

Dizziness in aging: A retrospective study of 1194 cases. Otolaryngol Head Neck Surg. 1994 Mar;110(3):296-301.


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

1 comment:

  1. I know it says you rarely comment on here but I'm going to try anyway.im having vertigo problems, been diagnosed long ago with labrynthitis, having a dizzy spell, as I call them, can't get it to stop with the manuevers.... Dix halpike test very little to right but third position(face downwards) really get lots of nystagmus and vertigo then,supine roll positive to left side. Any ideas ? I can't get rid of the stuffy head, headaches or dizziness. Any help is appreciated. Thank you, Amy achulin922@rocketmail.com

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