Benign paroxysmal positional vertigo in Germany: prevalence and health-care utilisation

• Published in: Aktuelle Neurologie
• Main Authors: von Brevern, M, Radtke, A, Lezius, F, Feldmann, M, Ziese, T, Lempert, T, Neuhauser, H
• Format: Conference Proceeding
• Language: German
• Published: 07.09.2004
• ISSN: 0302-4350; 1438-9428
• DOI: 10.1055/s-2004-833126

Benign paroxysmal positional vertigo (BPPV) is nowadays the most successfully treatable cause of vertigo. In specialized dizziness clinics, BPPV is the most common vestibular disorder accounting for about 20% of referrals, however, its prevalence in the general population is not known. The aim of the study was to determine the prevalence of BPPV in the general adult population. A nationwide computer-assisted telephone interview (CATI) survey was conducted with a representative sample of 4869 men and women aged 18 years and older residing in Germany. The CATI identified 1403 subjects with a history of moderate or severe dizziness or vertigo, 1157 of whom were willing to participate in a detailed dizziness interview conducted via telephone by medical students thoroughly trained in a dizziness clinic. Each interview was discussed with a specialised neurotologist. Diagnostic criteria for BPPV were: at least five attacks of vestibular vertigo lasting less than 1 minute provoked by changes of head position such as lying down and turning over in bed. In a concurrent validation study, 61 patients were interviewed by telefone and independently examined by a neurologist specialised in neuro-otology. BPPV was detected by telefone interview with a specificity of 92% and a sensitivity of 88%. From the original sample (n=1157) 1003 interviews were completed (response rate 87%, n=154 could not be reached or refused to participate). Vestibular vertigo was reported by 243 participants (178 women and 65 men), of whom 80 fulfilled the criteria for BPPV (24 men and 56 women). The mean age at onset of BPPV was 49.4 (SD13.9)years. BPPV attacks within the last 12 months were reported by 53 participants (66%). The proportion of BPPV in the dizziness group varied with age: 2.3% (men 2.0%; women 2.4%) in the age group 18–39 years, 10.6% (7.8%; 12.0%) in the age group 40–59 years and 14.9% (14.6%; 15.0%) in the age group>60 years. The estimated lifetime prevalence of BPPV in the general population in the three age groups was 0.5%, 1.6% and 3.6% in men and 1.0%, 3.8% and 5.7% in women. Most patients (78%) had seeked medical advice for positional vertigo but paraphrased diagnoses could be interpreted only in 21% of them as BPPV. BPPV is a common cause for vertigo in the general population. The prevalence of BPPV increases with age and has a female preponderance. Misdiagnosis of BPPV seems to be frequent in Germany, in spite of high health care utilisation.