Risk of traffic accidents after onset of vestibular disease assessed with a surrogate marker

  • Doreen HuppertEmail author
  • Andreas Straube
  • Lucia Albers
  • Rüdiger von Kries
  • Viola Obermeier
Original Communication



To determine if the risk of traffic accidents increases after disease onset in patients with acute vestibular disorders. That could provide a valid rationale for guidelines on driving restrictions.


5,260,054 patient data (> 18 years of age) from a statutory health insurer were used to identify traffic injuries in incident cases of Menière’s disease (MD) and vestibular neuritis (VN) in 2010–2013. Incident diagnoses were defined as the absence of such diagnoses in the preceding 5 years. Comparators were insured individuals with no such diagnoses throughout 2005–2017. The surrogate for traffic injuries were whiplash injuries coded in ICD-10 as diagnosis of sprain of ligaments of the cervical spine without structural changes.


We identified 4509 incident patients with Menière’s disease and 25,448 with vestibular neuritis and 5,102,655 controls with no such diagnoses throughout the observation period. The incidence of traffic injuries was increased for both vestibular disorders prior to the time point of diagnosis—MD 0.72 [0.47; 0.97] and VN 0.66 [0.56; 0.76] compared to controls (0.46 [0.46; 0.47]). The temporal course of incidence in whiplash injuries showed no increase and was 0.64 [0.41; 0.88] for MD at diagnosis and 0.73 [0.48; 0.98] after diagnosis, for VN it was 0.81 [0.70; 0.92] at diagnosis and 0.65 [0.55; 0.74] after diagnosis.


Although these data were not originally collected to address the research question, they provide a valid body of evidence. There is no rationale for driving restrictions, which substantially interfere with the individuals’ quality of life, in patients with incident MD and VN.


Vestibular disease Vestibular neuritis Menière’s disease Traffic accidents Incidence study 



The authors thank Dr. Ursula Marshall and Joachim Saam (BARMER) for providing the data and for their tremendous help in dealing with the data structure of the BARMER health insurance data. They also thank Judy Benson and Katie Göttlinger for copyediting the manuscript. This work was supported by funds from the German Federal Ministry of Education and Research (BMBF Grant code 01 EO 0901) and the Hertie Foundation.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Levo H, Stephens D, Kentala E, Poe D, Pyykkö I (2012) EuroQol 5D quality of life in Menière’s disorder can be explained with symptoms and disabilities. Int J Rehabil Res 35:197–202CrossRefGoogle Scholar
  2. 2.
    Page NGR, Gresty MA (1985) Motorist’s vestibular disorientation syndrome. J Neurol Neurosurg Psychiatry 48:729–735CrossRefGoogle Scholar
  3. 3.
    Cohen HS, Wells J, Kimball KT, Owsley C (2003) Driving disability and dizziness. J Saf Res 34:361–369CrossRefGoogle Scholar
  4. 4.
    Neuhauser K (2007) Epidemiology of vertigo. Curr Opin Neurol 20:40–46CrossRefGoogle Scholar
  5. 5.
    Huppert D, Pyykkö I, Magnusson M, Straumann D, Brandt T (2018) Dizziness in Europe: from licensed fitness to drive to licence without fitness to drive. J Neurol 265:9–17CrossRefGoogle Scholar
  6. 6.
    Hornio A (1961) Does epilepsy mean higher susceptibility to traffic accidents? Acta Psychiatr Scand 150:210–212Google Scholar
  7. 7.
    Waller JA (1965) Chronic medical conditions and traffic safety: review of the California experience. N Engl J Med 273:1413–1420CrossRefGoogle Scholar
  8. 8.
    Hansotia P, Broste SK (1991) The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. N Engl J Med 324:22–26CrossRefGoogle Scholar
  9. 9.
    Adam C (2015) Epilepsy and driving. Presse Med 44:1029–1033CrossRefGoogle Scholar
  10. 10.
    Pyykkö I, Kentala E, Levo H, Manchaiah V, Kallunki N (2017) Car driving in Meniere’s disease—is it safe. Finn Meniere Post 17:7–10Google Scholar
  11. 11.
    Wei EX, Agrawal Y (2018) Association between vestibular vertigo and motor vehicle accidents: data from the 2016 National Health Interview Survey. Ear Hear 39:1232–1235CrossRefGoogle Scholar
  12. 12.
    Tanaka N, Atesok K, Nakanishi K, Kameoi N, Nakamae T, Kotaka S, Adachi N (2018) Pathology and treatment of traumatic cervical spine syndrome: whiplash injury. Adv Orthop. Google Scholar
  13. 13.
    Sterner Y, Gerdle B (2004) Acute and chronic whiplash disorders—a review. J Rehabil Med 36:193–209CrossRefGoogle Scholar
  14. 14.
    Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Côté P, Guzman J, Peloso PM, Nordin M, Hurwitz E, van der Velde G, Carragee EJ, Haldeman S (2008) The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions. Spine 33:S52–S59CrossRefGoogle Scholar
  15. 15.
    Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J (2008) Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Spine 33:S83–S92CrossRefGoogle Scholar
  16. 16.
    Jang SH, Kwon YH (2018) A review of traumatic axonal injury following whiplash injury as demonstrated by diffusion tensor tractography. Front Neurol. Google Scholar
  17. 17.
    Graf M, Grill C, Wedig HD (2009) Beschleunigungsverletzung der Halswirbelsäule. HWS-Schleudertrauma. Steinkopff Verlag, WürzburgCrossRefGoogle Scholar
  18. 18.
    Hoffmann F, Icks A (2012) Unterschiede in der Versichertenstruktur von Krankenkassen und deren Auswirkungen für die Versorgungsforschung: Ergebnisse des Bertelsmann-Gesundheitsmonitors. Gesundheitswesen 74:291–297CrossRefGoogle Scholar
  19. 19.
    Bewertung der Kodierqualität von vertragsärztlichen Diagnosen. Eine Studie im Auftrag des GKV-Spitzenverbands in Kooperation mit der BARMER GEK (2018) Accessed 23 Oct 2018
  20. 20.
    Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandala M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A (2015) Diagnostic criteria for Meniere’s disease. J Vestib Res 25:1–7Google Scholar
  21. 21.
    Brandt T, Dieterich M, Strupp M (2013) Vertigo and dizziness: common complaints, 2nd edn. Springer, LondonCrossRefGoogle Scholar
  22. 22.
    Halmagyi GM, Weber KP, Curthoys IS (2010) Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci 28:37–46Google Scholar
  23. 23.
    Adrion C, Fischer CS, Wagner J, Gürkov R, Mansmann U, Strupp M (2016) Efficacy and safety of betahistine treatment in patients with Menière’s disease: primary results of a long term, multicenter, double blind, randomized, placebo controlled, dose defining trial (BEMED trial). BMJ. Google Scholar
  24. 24.
    Huppert D, Strupp M, Theil D, Glaser M, Brandt T (2006) Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 67:1870–1871CrossRefGoogle Scholar
  25. 25.
    Huppert D, Strupp M, Brandt T (2010) Long-term course of Menière’s disease revisited. Acta Otolaryngol 130:644–651CrossRefGoogle Scholar
  26. 26.
    Brandt T, Zwergal A, Jahn K, Strupp M (2010) Institutional profile: integrated center for research and treatment of vertigo, balance and ocular motor disorders. Restor Neurol Neurosci 28:135–143Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Doreen Huppert
    • 1
    Email author
  • Andreas Straube
    • 2
  • Lucia Albers
    • 3
  • Rüdiger von Kries
    • 3
  • Viola Obermeier
    • 3
  1. 1.Institute for Clinical Neurosciences and German Center for Vertigo and Balance DisordersLudwig-Maximilians-Universität MünchenMunichGermany
  2. 2.Department of NeurologyLudwig-Maximilians-Universität MünchenMunichGermany
  3. 3.Division of Epidemiology, Institute of Social Paediatrics and Adolescents MedicineLudwig-Maximilians-Universität MünchenMunichGermany

Personalised recommendations