A retrospective analysis of two tertiary care dizziness clinics: A multidisciplinary chronic dizziness clinic and an acute dizziness clinic

Abstract

BackgroundVertigo remains a diagnostic challenge for primary care, emergency, and specialist physicians. Multidisciplinary clinics are increasingly being employed to diagnose and manage patients with dizziness. We describe, for the first time in Canada, the clinical characteristics of patients presenting with chronic and acute dizziness to both a multidisciplinary chronic dizziness clinic (MDC) and a rapid access dizziness (RAD) clinic at The Ottawa Hospital (TOH).MethodsWe performed a retrospective review of all patients presenting to the MDC and RAD clinics at TOH from July 2015 to August 2017.ResultsOverall, 211 patients (median age: 61 years old) presented to the RAD clinic and 292 patients (median age: 55 years old) presented to the MDC. In the RAD clinic, 63% of patients had peripheral dizziness, of which 55% had BPPV, and only one patient had functional dizziness. Interestingly, only 25% of RAD diagnoses were concordant with emergency department diagnoses; moreover, only 33% of RAD patients had HiNTS completed, while 44% had CT scans, of which only one scan had an abnormal finding. Prior to assessment, all patients in the MDC had an unclear cause of dizziness. 28% of patients had vestibular dizziness and 21% had functional dizziness, of which 43% had persistent postural perceptual dizziness. Moreover, 12% of patients with functional dizziness also suffered from comorbid severe anxiety and depression.ConclusionsDizziness is a heterogeneous disorder that necessitates multidisciplinary care, and clinics targeting both the acute and chronic setting can improve diagnostic accuracy, ensure appropriate diagnostic testing, and facilitate effective care plans for patients with dizziness.

The utility of brain CT scan modality in the management of dizziness at the emergency department: A retrospective single-center study

“…Staibano et al observed a significant proportion of females for dizziness [ 19 ]. Women are believed to be more sensitive to dizziness and imbalance and feel a greater influence on their daily activities.…”

Multimodal treatment of persistent postural–perceptual dizziness

“…Functional comorbidity is very common in patients with chronic dizziness (Staibano et al., 2019). Approximately 30%–50% of persistent dizziness cannot be fully explained by an identifiable medical illness (Schmid et al., 2011), and these patients mostly do not reveal any pathological results in technical diagnostics.…”

Persistent Postural-Perceptual Dizziness

“…10,11 More recent studies from centers that included PPPD in their diagnostic schema found that number was reduced to fewer than 2% of new patient evaluations. 11,12 Moreover, long-standing symptoms nonspecifically attributed to chronic vestibulopathy in the past were more properly diagnosed as PPPD.…”

“…13,14 In tertiary centers, these conditions constituted the principal diagnosis in 15 to 20% of all patients presenting for evaluation of vestibular symptoms, making them the most common diagnoses among young to middle-aged adults and the second most common among all adults, trailing only benign paroxysmal positional vertigo. Based on these older data and the most recent reports from tertiary neuro-otologic practices, 11,12 PPPD would be expected to rank among the top-three diagnoses encountered in referral centers, along with benign paroxysmal positional vertigo and vestibular migraine. The incidence and prevalence of PPPD in primary care and the general population are not known.…”