Connecting the Dots: Part II

dotsIn an attempt to answer some of the questions posed last week about the dramatic decrease in the number of vestibular tests performed, let’s review several recent articles related to management of patients who complain of dizziness. Click on the highlighted links for additional information. This information pertains only to patients presenting to the Emergency Room. They represent only a small percentage of total doctor visits for dizziness, but ER data is more readily available.

 

Question #1: Are fewer patients complaining of dizziness?

No. The number of ER visits for dizziness increased by 37% from 1995 to 2011.

 

Question #2: If these patients are not getting vestibular testing and treatment, what is being done to address their complaints?

Utilization of neuro-imaging for dizziness (mostly cranial CT scanning and some MRI) increased from being ordered on approximately 10% of patients complaining of dizziness to over 40% over the same time period. Cranial CT scan was ordered on 39% of dizzy patients in 2011 study.

 

Question #3: Are there newer, more effective methods to diagnose these patients that are replacing vestibular testing?

The simple answer is “No.” CT scanning is not new, and it is not effective. By comparison, thorough vestibular testing has been shown to be 88% to 90% effective in determining the cause of dizziness. Cranial CT has a diagnostic yield of about 1%-2% for patients complaining of vertigo or dizziness, and CT scanning misses emerging brainstem or cerebellar stroke (presumably the reason for ordering the scan) 60% to 80% of the time. Costs for ER services alone related to dizziness are estimated at $4 billion a year as of 2011.

 

The Bottom Line?

Ruling IN a common and easily treated benign vestibular disorder often safely rules OUT a rare but worrisome stroke or mass lesion.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.