Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance

• Published in: American journal of otolaryngology 2013-09, Vol.34 (5), p.471-476
• Main Authors: Jeon, Eun-Ju, MD, PhD, Park, Yong-Soo, MD, Park, Shi-Nae, MD, Park, Kyoung-Ho, MD, Kim, Dong-Hyun, MD, Nam, In-Chul, MD, Chang, Ki-Hong, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Benign Paroxysmal Positional Vertigo; Blood pressure; Cardiac arrhythmia; Diagnosis, Differential; Dizziness - diagnosis; Dizziness - etiology; Dizziness - physiopathology; Fainting; Female; Heart rate; Humans; Male; Middle Aged; Older people; Orthostatic Intolerance - complications; Orthostatic Intolerance - diagnosis; Orthostatic Intolerance - physiopathology; Otolaryngology; Patients; Posture - physiology; Questionnaires; Surgery; Tilt-Table Test; Vertigo; Vertigo - complications; Vertigo - diagnosis; Vertigo - physiopathology; Young Adult
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2013.04.005

Abstract Purpose Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI). Patients and Methods Patients presenting with OD (n = 102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI. Results The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n = 10) was most frequently found, followed by orthostatic hypertension (n = 5), and orthostatic tachycardia (n = 2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) ( P = 0.039). Conclusion It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.