Skip to main content
SpringerLink
Log in

Schwindelerkrankungen in einem tertiären HNO-Notfallzentrum

Dizziness and vertigo in a tertiary ENT emergency department

  • Originalien
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Obwohl Schwindel einer der häufigsten Gründe für die Vorstellung auf einer Notfallstation ist, bleiben viele dieser Patienten ohne Diagnose.

Ziel der Arbeit

In der vorliegenden Arbeit haben wir die der Bandbreite von Schwindel in einem tertiären HNO-Notfallzentrum untersucht. Darüber hinaus werteten wir die vorhandenen Symptome, klinischen Zeichen und durchgeführte Diagnostik aus.

Material und Methoden

Vom 01/2013 bis 12/2013 wurden alle Notfallberichte von Patienten, welche wegen Schwindels an das universitäre HNO-Notfallzentrum überwiesen wurden, gescreent und die Daten zu den Notfallkonsultationen ausgewertet.

Ergebnisse

Gesamthaft wurden 2596 Fälle mit Schwindel als Haupt- oder Begleitsymptom identifiziert. Davon wurden 286 einem HNO-Spezialisten zugewiesen, entweder direkt (n = 98) oder über eine andere Fachrichtung (n = 188). Benigner paroxysmaler Lagerungsschwindel (BPLS) war die häufigste Diagnose in unserer Studie (n = 46, 16,1 %), gefolgt von Neuritis vestibularis (n = 44, 15,4 %) und Otitis media (n = 20, 7 %). Einen ischämischen Schlaganfall oder TIA erlitten 9 Patienten (3,1 %). In 70 Fällen (24,5 %) war der Schwindel nicht näher spezifiziert.

Schlussfolgerung

BPLS ist die häufigste Schwindeldiagnose auf der HNO-Notfallstation. Allerdings sollten Ärzte Nystagmus präziser dokumentieren und systematisch diagnostische Manöver anwenden, damit eine genaue Diagnose gestellt werden kann. Ärzte und HNO-Fachärzte sollten zudem zentrale Zeichen bei Patienten mit einem akuten vestibulären Syndrom erkennen können, um eine Fehldiagnose zu vermeiden. Jeder vierte Patient erhielt keine definitive Diagnose. Es braucht deshalb eine verbesserte diagnostische Aufarbeitung der Schwindelpatienten.

Abstract

Background

Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed.

Objective

In this cross-sectional study, we investigated the spectrum of vertigo and dizziness in a tertiary ear, nose, and throat (ENT) emergency department (ED). Furthermore, we investigated the attendant symptoms, clinical signs, and the diagnostic tests performed.

Methods

We screened all ED reports from 01/2013 to 12/2013 for adult patients with vestibular symptoms referred to the ENT department.

Results

In total, we found 2596 cases with reported vestibular symptoms in the ED as a main or accompanying complaint. Of these, 286 were referred to the ENT specialist directly (n = 98) or via other major medical specialties (n = 188). Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n = 46, 16.1%), followed by vestibular neuritis (n = 44, 15.4%), otitis media (n = 20, 7%), and 9 patients (3.1%) had an ischemic stroke or a transient ischemic attack. In 70 (24.5%) cases, dizziness was not further specified.

Conclusion

BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Anonymous (1995) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–185

    Article  Google Scholar 

  2. Bisdorff A, Von Brevern M, Lempert T et al (2009) Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 19:1–13

    Article  Google Scholar 

  3. Boselli F, Kleiser L, Bockisch CJ et al (2014) Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions. J Biomech 47:1853–1860

    Article  CAS  Google Scholar 

  4. Brandt T, Dieterich M, Strupp M (2013) Vertigo – Leitsymptom Schwindel. Springer, Berlin Heidelberg

    Book  Google Scholar 

  5. Buki B, Simon L, Garab S et al (2011) Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus. J Neurol Neurosurg Psychiatry 82:98–104

    Article  Google Scholar 

  6. Chu CH, Liu CJ, Lin LY et al (2015) Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain 16:62

    Article  Google Scholar 

  7. Ewald RJ (1892) Physiologische Untersuchungen ueber das Endorgan des Nervus Octavus. Bergmann, Wiesbaden

    Google Scholar 

  8. Geser R, Straumann D (2012) Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neur 3:169

    Article  Google Scholar 

  9. Goeldlin M, Gaschen J, Kammer C et al (2019) Frequency, etiology and impact of vestibular symptoms in the emergency department: a neglected red flag. J Neurol. https://doi.org/10.1007/s00415-019-09525-4

    Article  PubMed  PubMed Central  Google Scholar 

  10. Huh YE, Kim JS (2011) Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations. Brain 134:3662–3671

    Article  Google Scholar 

  11. Im DH, Yang YS, Choi H et al (2017) Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis. Medicine 96:e7849

    Article  Google Scholar 

  12. Kattah JC, Talkad AV, Wang DZ et al (2009) HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–3510

    Article  Google Scholar 

  13. Kerber KA, Meurer WJ, West BT et al (2008) Dizziness presentations in U.S. emergency departments, 1995–2004. Acad Emerg Med 15:744–750

    Article  Google Scholar 

  14. Kim H‑J, Lee S‑H, Park JH et al (2014) Isolated vestibular nuclear infarction: report of two cases and review of the literature. J Neurol 261:121–129

    Article  Google Scholar 

  15. Kim HA, Lee H (2012) Recent advances in central acute vestibular syndrome of a vascular cause. J Neurol Sci 321:17–22

    Article  Google Scholar 

  16. Kim S‑H, Zee DS, Du Lac S et al (2016) Nucleus prepositus hypoglossi lesions produce a unique ocular motor syndrome. Neurology 87:2026–2033

    Article  Google Scholar 

  17. Kroenke K, Price RK (1993) Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153:2474–2480

    Article  CAS  Google Scholar 

  18. Lohler J, Esser D, Wollenberg B et al (2018) Primärversorgung von akutem Schwindel : Patienten in Notfallambulanzen in Deutschland [Management of acute vertigo and dizziness : Patients in emergency departments in Germany]. HNO 66:472–479

    Article  CAS  Google Scholar 

  19. Lopez-Escamez JA, Carey J, Chung WH et al (2015) Diagnostic criteria for Meniere’s disease. J Vestib Res 25:1–7

    Article  Google Scholar 

  20. Mcclure JA (1985) Horizontal canal BPV. J Otolaryngol 14:30–35

    CAS  PubMed  Google Scholar 

  21. Morris ZS, Wooding S, Grant J (2011) The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 104:510–520

    Article  Google Scholar 

  22. Murdin L, Schilder AG (2015) Epidemiology of balance symptoms and disorders in the community: a systematic review. Otol Neurotol 36:387–392

    Article  Google Scholar 

  23. Neuhauser HK (2009) Epidemiologie von Schwindelerkrankungen [Epidemiology of dizziness and vertigo]. Nervenarzt 80:887–894

    Article  CAS  Google Scholar 

  24. Neuhauser HK (2007) Epidemiology of vertigo. Curr Opin Neurol 20:40–46

    Article  Google Scholar 

  25. Neuhauser HK, Radtke A, Von Brevern M et al (2008) Burden of dizziness and vertigo in the community. Arch Intern Med 168:2118–2124

    Article  Google Scholar 

  26. Newman-Toker DE (2012) Symptoms and signs of neuro-otologic disorders. Continuum 18:1016–1040

    PubMed  Google Scholar 

  27. Newman-Toker DE, Cannon LM, Stofferahn ME et al (2007) Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 82:1329–1340

    Article  Google Scholar 

  28. Newman-Toker DE, Edlow JA (2015) TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin 33:577–599

    Article  Google Scholar 

  29. Newman-Toker DE, Hsieh YH, Camargo CA Jr. et al (2008) Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 83:765–775

    Article  Google Scholar 

  30. Newman-Toker DE, Kerber KA, Hsieh YH et al (2013) HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 20:986–996

    Article  Google Scholar 

  31. Saber Tehrani AS, Kattah JC, Mantokoudis G et al (2014) Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology 83:169–173

    Article  Google Scholar 

  32. Stanton VA, Hsieh YH, Camargo CA Jr. et al (2007) Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proc 82:1319–1328

    Article  Google Scholar 

  33. Tarnutzer AA, Berkowitz AL, Robinson KA et al (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183:E571–E592

    Article  Google Scholar 

  34. Venhovens J, Meulstee J, Verhagen WI (2016) Acute vestibular syndrome: a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department. J Neurol 263:2151–2157

    Article  CAS  Google Scholar 

  35. Von Brevern M, Bertholon P, Brandt T et al (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 25:105–117

    Article  Google Scholar 

  36. Walther LE (2017) Moderne Schwindeldiagnostik [Current diagnostic procedures for diagnosing vertigo and dizziness]. Laryngo-Rhino-Otol 96:183–208

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz

    L. Comolli, M. D. Caversaccio &  G. Mantokoudis

  2. Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz

    M. Goeldlin, J. Gaschen, C. Kammer, R. Kalla & U. Fischer

  3. Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz

    T. C. Sauter

Authors
  1. L. Comolli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Goeldlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Gaschen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Kammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. C. Sauter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. D. Caversaccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Kalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. Mantokoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Mantokoudis.

Ethics declarations

Interessenkonflikt

L. Comolli, M. Goeldlin, J. Gaschen, C. Kammer, T. Sauter, M.D. Caversaccio, R. Kalla, U. Fischer und G. Mantokoudis geben an, dass kein Interessenkonflikt besteht. M. Goeldlin wurde durch einen Young Talents in Clinical Research Grant der Bangerter-Rhyner Stiftung unterstützt (YTCR 13/18). G. Mantokoudis wurde durch den Schweizerischen Nationalfonds unterstützt (Grant #320030_173081).

Diese retrospektive Studie wurde von der zuständigen Ethikkommission bewilligt.

Additional information

L. Comolli und M. Goeldlin: Geteilte Erstautorenschaft. U. Fischer und G. Mantokoudis: Geteilte Letzautorenschaft.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Comolli, L., Goeldlin, M., Gaschen, J. et al. Schwindelerkrankungen in einem tertiären HNO-Notfallzentrum. HNO 68, 763–772 (2020). https://doi.org/10.1007/s00106-020-00857-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-020-00857-6

Schlüsselwörter

Keywords

Search

Navigation