Abstract
People aged over 50 are the most likely to present to a physician for dizziness. It is important to identify the main cause of dizziness in order to develop the best treatment approach. Our goal was to determine the prevalence of benign paroxysmal positional vertigo (BPPV), and peripheral and central vestibular function in people that had experienced dizziness within the past year aged over 50. One hundred and ninety three community-dwelling participants aged 51–92 (68 ± 8.7 years; 117 females) were tested using the clinical and video head impulse test (cHIT and vHIT) to test high-frequency vestibular organ function; the head thrust dynamic visual acuity (htDVA) test to test high-frequency visual-stability; the dizziness handicap inventory (DHI) to measure the impact of dizziness; as well as sinusoidal and unidirectional rotational chair testing to test low- to mid-frequency peripheral and central vestibular function. From these assessments we computed the following measures: HIT gain; htDVA score; DHI score; sinusoidal (whole-body; 0.1–2 Hz with 30°/s peak-velocity) vestibulo-ocular reflex (VOR) gain and phase; transient (whole-body, 150°/s2 acceleration to 50°/s constant velocity) VOR gain and time constant; optokinetic nystagmus (OKN) gain and time constant (whole-body, 50°/s constant velocity rotation). Our study showed that BPPV, and peripheral or central vestibular hypofunction were present in 34% of participants, suggesting a vestibular cause to their dizziness. Over half (57%) of these with a likely vestibular cause had BPPV, which is more than twice the percentage reported in other dizzy clinic studies. Our findings suggest that the physical DHI score and VOR time constant were best at detecting those with non-BPPV vestibular loss, but should always be used in conjunction with cHIT or vHIT, and that the htDVA score and vHIT gain were best at detecting differences between ipsilesional and contralesional sides.
Highlights
The vestibular system plays a key role in maintaining balance, stable gait, and stable vision during head movement via the vestibulo-ocular reflex (VOR)
Non-vestibular dizzy patients were best determined by negative cHIT and vHIT gain
BPPV patients were best determined by a high maximum htDVA score
Summary
The vestibular system plays a key role in maintaining balance, stable gait, and stable vision during head movement via the vestibulo-ocular reflex (VOR). Studies that have investigated the prevalence of vestibular impairment among people with dizziness have all been predominantly in a primary care setting and /or specialist ENT clinics; little data are available on the prevalence of vestibular causes of dizziness among an older communitydwelling population. This is an important issue to address because identifying the primary cause leads to targeted and effective rehabilitation, e.g., vestibular rehabilitation has been shown to improve the quality of life of patients suffering from imbalance and dizziness [10]. Improvements in identifying these people are important so that they can receive timely rehabilitation treatment and potentially avoid further debilitating and lifethreatening injuries
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