QJM Advance Access originally published online on April 8, 2005
QJM 2005 98(5):357-364; doi:10.1093/qjmed/hci057
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Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit
From the 1Falls and Syncope Service, Care of the Elderly Offices, Royal Victoria Infirmary, Newcastle, 2Regional ENT Service, Freeman Hospital, Newcastle, and 3Department of Neuro–otology, National Hospital for Neurology and Neurosurgery, London, UK
Address correspondence to Dr J.L. Newton, Falls and Syncope Service, Care of the Elderly Offices, Royal Victoria Infirmary, Newcastle NE1 4LP. e-mail: julia.newton{at}nuth.northy.nhs.uk
Received 29 September 2004 and in revised form 21 January 2005
Background: Dizziness is a common symptom in older people that affects quality of life and increases the risk of falls. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that increases in prevalence with age, and is potentially curable.
Aim: To compare patients with BPPV referred initially to a Falls and Syncope Unit (FSS group) with those initially referred to a Regional ENT/Balance Service (ENT group).
Design: Retrospective case-note review.
Methods: Medical notes, investigations and outcomes were reviewed for all patients.
Results: Of 59 patients with BPPV confirmed by Dix-Hallpike test, 31 (53%) were initially referred to the FSS (2.6 patients per month, 71% females) and 28 (47%) were initially referred to ENT (4.7 patients per month, 86% females). Compared to those referred initially to ENT, FSS patients were significantly older (mean ± SD 69 ± 13 vs. 55.4 ± 13 years, p = 0.0003) and had dizzy symptoms for longer before diagnosis (median (range) 12 (4–120) vs. 6 (1–36) months, p = 0.0273). FSS patients were more likely to have more than one type of dizziness (16% vs. 0%, p = 0.001), more likely to have cerebrovascular or cardiovascular co-morbidity (13% vs. 4%, p = 0.0152) and were taking significantly more medications (3.2 vs. 1.7; p = 0.0271). Cure rates on intervention were similar (83% FSS, 86% ENT).
Discussion: BPPV is a potentially curable cause for dizziness in older people. Older people are frequently referred directly to Falls units, who will be seeing increasing numbers of patients with dizziness. A high index of suspicion allows early identification and treatment of this condition.
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