Skip to main content


Log in

Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript


This study aimed to determine the etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. We analyzed the diagnoses of 21,166 consecutive dizzy patients (12,691 women, mean age = 57.9 ± 15.7, age range = 3–97) seen from 2003 to 2019 using a registry and medical records. Overall, dizziness and vertigo were more common in women (60.0%, CI 0.59–0.61) than in men without a difference in age (57.7 ± 15.5 vs. 58.1 ± 16.1, p = 0.094). Benign paroxysmal positional vertigo (BPPV, 24.1%) was the most common cause of dizziness/vertigo, followed by psychiatric or persistent postural perceptual dizziness (20.8%), vascular disorders (12.9%), vestibular migraine (10.2%), Meniere’s disease (7.2%), and vestibular neuritis (5.4%). These six disorders comprised more than 80% of all disorders. The etiology could not be determined in 5.0%, and more than one etiology was found in 14.1%. Vestibular migraine was the most common disorder in children and adolescents (< 19 years), psychiatric or persistent postural perceptual dizziness (26.3%) in the adults (19–64 years), and BPPV (28.2%) in the elderly (≥ 65 years). This etiologic distribution is similar to that reported in another country, and indicates no significant differences in the proportion of diseases causing dizziness and vertigo across different ethnic groups. This study provides valuable information to establish healthcare policy for dizziness and vertigo.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Murdin L, Schilder AG (2015) Epidemiology of balance symptoms and disorders in the community: a systematic review. Otol Neurotol 36(3):387–392.

    Article  PubMed  Google Scholar 

  2. Kroenke K, Price RK (1993) Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153(21):2474–2480

    Article  CAS  Google Scholar 

  3. Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T (2005) Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 65(6):898–904.

    Article  CAS  PubMed  Google Scholar 

  4. Strupp M, Brandt T (2008) Diagnosis and treatment of vertigo and dizziness. Dtsch Arztebl Int 105(10):173–180.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kruschinski C, Kersting M, Breull A, Kochen MM, Koschack J, Hummers-Pradier E (2008) Frequency of dizziness-related diagnoses and prescriptions in a general practice database. Z Evid Fortbild Qual Gesundhwes 102(5):313–319.

    Article  PubMed  Google Scholar 

  6. Bisdorff AR, Staab JP, Newman-Toker DE (2015) Overview of the international classification of vestibular disorders. Neurol Clin 33(3):541–550, vii.

    Article  PubMed  Google Scholar 

  7. Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandala M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A, Classification Committee of the Barany S, Japan Society for Equilibrium R, European Academy of O, Neurotology, Equilibrium Committee of the American Academy of O-H, Neck S, Korean Balance S (2015) Diagnostic criteria for Meniere's disease. J Vestib Res 25(1):1–7.

    Article  Google Scholar 

  8. Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, Strupp M, Kim JS (2019) Hemodynamic orthostatic dizziness/vertigo: diagnostic criteria. J Vestib Res 29(2–3):45–56.

    Article  PubMed  Google Scholar 

  9. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A (2017) Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the Classification of Vestibular Disorders of the Barany Society. J Vestib Res 27(4):191–208.

    Article  PubMed  Google Scholar 

  10. Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, Della Santina CC, Kingma H (2017) Bilateral vestibulopathy: diagnostic criteria consensus document of the Classification Committee of the Barany Society. J Vestib Res 27(4):177–189.

    Article  PubMed  Google Scholar 

  11. Strupp M, Lopez-Escamez JA, Kim JS, Straumann D, Jen JC, Carey J, Bisdorff A, Brandt T (2016) Vestibular paroxysmia: diagnostic criteria. J Vestib Res 26(5–6):409–415.

    Article  PubMed  Google Scholar 

  12. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 25(3–4):105–117.

    Article  Google Scholar 

  13. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D (2012) Vestibular migraine: diagnostic criteria. J Vestib Res 22(4):167–172.

    Article  Google Scholar 

  14. Goebel JA (2016) 2015 equilibrium Committee Amendment to the 1995 AAO-HNS guidelines for the definition of Meniere's disease. Otolaryngol Head Neck Surg 154(3):403–404.

    Article  PubMed  Google Scholar 

  15. Brandt T, Dieterich M (1994) Vestibular paroxysmia: vascular compression of the eighth nerve? Lancet 343(8900):798–799.

    Article  CAS  PubMed  Google Scholar 

  16. Brandt T (1996) Phobic postural vertigo. Neurology 46(6):1515–1519.

    Article  CAS  PubMed  Google Scholar 

  17. Dieterich M, Staab JP, Brandt T (2016) Functional (psychogenic) dizziness. Handb Clin Neurol 139:447–468.

    Article  CAS  PubMed  Google Scholar 

  18. Kim S, Oh YM, Koo JW, Kim JS (2011) Bilateral vestibulopathy: clinical characteristics and diagnostic criteria. Otol Neurotol 32(5):812–817.

    Article  PubMed  Google Scholar 

  19. Jeong SH, Kim HJ, Kim JS (2013) Vestibular neuritis. Semin Neurol 33(3):185–194.

    Article  PubMed  Google Scholar 

  20. Shiga A, Nakagawa T, Nakayama M, Endo T, Iguchi F, Kim TS, Naito Y, Ito J (2005) Aging effects on vestibulo-ocular responses in C57BL/6 mice: comparison with alteration in auditory function. Audiol Neurootol 10(2):97–104.

    Article  PubMed  Google Scholar 

  21. Chang CM, Young YH, Cheng PW (2012) Age-related changes in ocular vestibular-evoked myogenic potentials via galvanic vestibular stimulation and bone-conducted vibration modes. Acta Otolaryngol 132(12):1295–1300.

    Article  PubMed  Google Scholar 

  22. Kim HJ, Lee JH, Kim JS (2014) Ocular vestibular evoked myogenic potentials to head tap and cervical vestibular evoked myogenic potentials to air-conducted sounds in isolated internuclear ophthalmoplegia. Clin Neurophysiol 125(5):1042–1047.

    Article  PubMed  Google Scholar 

  23. Iwasaki S, Yamasoba T (2015) Dizziness and imbalance in the elderly: age-related decline in the vestibular system. Aging Dis 6(1):38–47.

    Article  PubMed  Google Scholar 

  24. Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K (2013) Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hear Res 303:30–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Cheng AG, Cunningham LL, Rubel EW (2005) Mechanisms of hair cell death and protection. Curr Opin Otolaryngol Head Neck Surg 13(6):343–348.

    Article  PubMed  Google Scholar 

  26. UN (2020) World Population Ageing 2019. vol ST/ESA/SER.A/444

  27. Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 37(3):371–378.

    Article  CAS  PubMed  Google Scholar 

  28. Kim HJ, Kim JS (2017) The patterns of recurrences in idiopathic benign paroxysmal positional vertigo and self-treatment evaluation. Front Neurol 8:690.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Staab JP, Ruckenstein MJ (2007) Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg 133(2):170–176.

    Article  PubMed  Google Scholar 

  30. Formeister EJ, Rizk HG, Kohn MA, Sharon JD (2018) The epidemiology of vestibular migraine: a population-based survey study. Otol Neurotol 39(8):1037–1044.

    Article  PubMed  Google Scholar 

  31. Ballester M, Liard P, Vibert D, Hausler R (2002) Meniere's disease in the elderly. Otol Neurotol 23(1):73–78.

    Article  PubMed  Google Scholar 

  32. Brandt T (2003) Vestibular neuritis. In: Vertigo. Springer, New York, pp 67–81. doi:10.1007/978-1-4757-3801-8

  33. Grad A, Baloh RW (1989) Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol 46(3):281–284.

    Article  CAS  PubMed  Google Scholar 

  34. Choi JH, Park MG, Choi SY, Park KP, Baik SK, Kim JS, Choi KD (2017) Acute transient vestibular syndrome: prevalence of stroke and efficacy of bedside evaluation. Stroke 48(3):556–562.

    Article  PubMed  Google Scholar 

  35. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (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(11):3504–3510.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bisdorff A, Bosser G, Gueguen R, Perrin P (2013) The epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities. Front Neurol 4:29.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB (2006) Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 37(10):2484–2487.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kuroda R, Nakada T, Ojima T, Serizawa M, Imai N, Yagi N, Tasaki A, Aoki M, Oiwa T, Ogane T, Mochizuki K, Kobari M, Miyajima H (2017) The TriAGe+ score for vertigo or dizziness: a diagnostic model for stroke in the emergency department. J Stroke Cerebrovasc Dis 26(5):1144–1153.

    Article  CAS  PubMed  Google Scholar 

  39. Choi SY, Kee HJ, Park JH, Kim HJ, Kim JS (2014) Combined peripheral and central vestibulopathy. J Vestib Res 24(5–6):443–451.

    Article  PubMed  Google Scholar 

  40. Brandt T, Strupp M, Dieterich M (2016) Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J Neurol 263(Suppl 1):S90–96.

    Article  PubMed  Google Scholar 

  41. Jannetta PJ, Moller MB, Moller AR (1984) Disabling positional vertigo. N Engl J Med 310(26):1700–1705.

    Article  CAS  PubMed  Google Scholar 

  42. Wuehr M, Brandt T, Schniepp R (2017) Distracting attention in phobic postural vertigo normalizes leg muscle activity and balance. Neurology 88(3):284–288.

    Article  PubMed  Google Scholar 

Download references


This study was supported by a grant of Seoul National University Bundang Hospital (06-2019-272). The authors thank the Medical Research Collaborating Center at Seoul National University Bundang Hospital for statistical analyses.

Author information

Authors and Affiliations



Dr. H-J Kim acquired and analyzed the data, and drafted the manuscript. Ms. J-O Lee and Dr. J-Y Choi interpreted the data. Dr. J-S. Kim conducted the design and conceptualization of the study, interpretation of the data, and revising the manuscript.

Corresponding author

Correspondence to Ji-Soo Kim.

Ethics declarations

Conflicts of interest

Dr. H-J Kim, Ms. J-O Lee, and Dr. J-Y Choi report no disclosures. Dr. J-S Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, and Journal of Vestibular Research. The other authors have nothing to disclose.

Ethical standards

This study followed the tenets of the Declaration of Helsinki and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (IRB no. B-1907-553-001).

Electronic supplementary material

Below is the link to the electronic supplementary material.


Supplementary file1 The female predominance was maintained across all age groups, and peaked in the sixth decade (PNG 131 kb)

Supplementary file2 (DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, HJ., Lee, JO., Choi, JY. et al. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol 267, 2252–2259 (2020).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: