Keywords
Epidemiology - Health Profile - Rehabilitation - Vertigo
INTRODUCTION
Vertigo is a symptom of vestibular dysfunction represented by a sensation of movement,[1] usually of the rotational type, as if the body or the environment were moving. This
sensation can be confused with dizziness, whereas vertigo is a type of dizziness.[2]
Vertigo can be a symptom of peripheral or central vestibular diseases, with a lifetime
prevalence of up to 10%[3] and an annual incidence of 1.4%,[4] although it may still be underestimated when performing an uncertain examination
of the vestibular and oculomotor system.[5] It is a common complaint in emergency and primary care,[1] in addition to causing significant restrictions in activities of daily living and
quality of life.[6]
Information received from the vestibular, visual, and somatosensory systems helps
maintain balance. In addition, there is the membranous labyrinth, which contains otolithic
organs (the saccule and utricle) and semicircular canals, which, when activated, enable
us to understand various physical movements in everyday life.[7] Vestibular disorders present symptoms of vertigo, most frequently, in decreasing
order, benign paroxysmal positional vertigo (BPPV), vestibular migraine, Ménière's
disease, and vestibular neuritis.[8] Many elderly people with vestibular disorders have a history of many depressive
and/or anxious symptoms, with a poor quality of life and persistent negative feelings
related to sadness.[9]
The diagnosis and treatment of the cause of vertigo vary according to its etiology
and site of involvement, with the diagnosis being established by physical examination,
positioning maneuvers or imaging tests.[10]
[11]
[12] The main and one of the most treatable causes of vertigo is BPPV, in which one or
more of the semicircular canals are abnormally stimulated by otoconia that are dislodged
from the otolith organs.[13] The benign disease has a prevalence ranging from 10.7 to 64 cases per 100 thousand
inhabitants, in addition to a lifetime prevalence estimated at 3.2% in women, 1.6%
in men, and 2.4% overall.[14]
Vestibular rehabilitation is the main treatment, and it has been proven useful in
resolving symptoms and improving body balance by restoring the sense of balance in
people suffering from vestibular dysfunction.[15]
[16] In the case of BPPV, rehabilitation is based on repetitive exercises, performed
through repositioning maneuvers.[17] Treatment of hypofunction uses vestibular stimulation to generate compensation,
while movement sensitivity treatments use habituation to reduce or eliminate the provocative
movements that cause dizziness.[18] However, BPPV is not the only cause of vertigo, and, for other diseases, systematic
therapeutic exercises and functional training on the ground, virtual reality, adaptations
to the home and the work environment can be performed.[19] When dealing with BPPV, the main cause of vertigo found in this study, most patients
require one or two consultations for symptom relief and functional recovery, although
some people may require several consultations for resolution.[16]
[20]
Vertigo is a very common symptom that causes many physical and psychological difficulties
for patients, in addition to increasing the cost of medical care. Therefore, knowing
the epidemiological profile of the patients and the main causes can provide valuable
information for the development of prevention strategies (in addition to generating
awareness of the symptom among the population), as well as health education and evaluations
of the impact of vestibular rehabilitation in the treatment of this clinical condition.
The objective of the present study was to analyze the epidemiological profile of patients
treated for vertigo and their postrehabilitation outcomes.
METHODS
Study design
We conducted a descriptive cross-sectional study, with collection of secondary data
from medical records of patients with complaints of vertigo, treated from 2021 to
2023 at a clinic specialized in vestibular rehabilitation.
Ethical aspects
The project was approved by the Ethics in Research Committee of Universidade do Extremo
Sul Catarinense (UNESC), under opinion number 6.438.092.
Study population
The medical records of 200 patients with complaints of vertigo, of all age groups,
treated from 2021 to 2023 at a private clinic specialized in vestibular rehabilitation,
in the city of Criciúma, state of Santa Catarina, Brazil, were evaluated through a
census collection.
Exclusion criteria
Patients with complaints of vertigo who did not adhere to the rehabilitation treatment.
Data collection
Information on sex, age, cause of vertigo, comorbidities, associated symptoms, medication
use, treatment adherence, and improvement were collected from the medical records.
Improvement was assessed through patient feedback, reported to the physiotherapist
or, when possible, in a face-to-face consultation to perform positional, ocular, and
balance tests. The interventions performed were repositioning maneuvers, in which
the patient underwent one session and returned or not, depending on the symptoms.
Since the study was conducted in a vestibular rehabilitation clinic, no treatment
medications were used.
Statistical analysis
The statistical analysis was performed using the IBM SPSS Statistics for Windows (IBM
Corp.) software, version 23.0. The qualitative variables were expressed as frequencies
and percentages, and the quantitative variables were expressed as mean and standard
deviation values.
RESULTS
A total of 200 medical records of individuals who underwent vestibular rehabilitation
with complaints of vertigo between 2021 and 2023 were evaluated, and 5 patients who
did not adhere to treatment were excluded from the data collection, resulting in a
total sample of 195 patients. The mean age of the sample was of 51.18 ± 16.84 years,
and 62.6% were female patients, as illustrated in [Table 1].
Table 1
Profile of the study sample
|
n = 195
|
|
Mean age (years)
|
51.18 ± 16.84
|
|
Sex: n (%)
|
Female
|
122 (62.6)
|
|
Male
|
73 (37.4)
|
[Table 2] shows the main causes of vertigo found. In total, 109 (55.9%) patients presented
BPPV as the cause of vertigo. Comorbidities and/or associated symptoms are described
in [Table 3], and patients may present more than one comorbidity. The most prevalent finding
was tinnitus (30.8%). In addition, 29.2% of the patients reported having depression
and/or anxiety, and 20.5%, systemic arterial hypertension (SAH). When analyzing each
individual, 30.8% had tinnitus, 29.2%, depression and/or anxiety, 20.5%, hypertension,
12.3%, hypercholesterolemia, 7.7%, type-2 diabetes mellitus (DM2), 7.7%, hypovitaminosis
D, and 4.1%, history of stroke.
Table 2
Causes of vertigo among the study sample
|
Cause: n (%)
|
n = 195
|
|
Benign paroxysmal positional vertigo
|
109 (55.9)
|
|
Vestibular neuritis
|
4 (2.1)
|
|
Ménière's disease
|
2 (1.0)
|
|
Other causes
|
48 (24.6)
|
|
No defined cause
|
32 (16.4)
|
Table 3
Comorbidities and/or associated symptoms of the study sample
|
Comorbidity and/or symptom: n (%)
|
n = 195*
|
|
Tinnitus
|
60 (30.8)
|
|
Depression and/or anxiety
|
57 (29.2)
|
|
Systemic arterial hypertension
|
40 (20.5)
|
|
Hypercholesterolemia
|
24 (12.3)
|
|
Diabetes mellitus
|
15 (7.7)
|
|
Hypovitaminosis D
|
15 (7.7)
|
|
Stroke history
|
8 (4.1)
|
|
Other comorbidity
|
84 (43.1)
|
Note: *Patients may present more than one comorbidity.
The patient outcomes are described in [Table 4]. Of the 195 participants, 193 (99%) showed improvement in vertigo after treatment,
with 58% improving after just 1 session. Of these 58%, although more than half had
BPPV as the cause, other causes may also be involved, and the number of sessions and
response to treatment is individual, regardless of the cause.
Table 4
Outcome of rehabilitation among the study sample
|
n = 195: n (%)
|
|
Adherence to treatment
|
195 (100)
|
|
Improvement after treatment
|
193 (99)
|
|
Improvement after how many sessions
|
1
|
122 (58)
|
|
2
|
45 (23.3)
|
|
3
|
19 (9.8)
|
|
≥ 4
|
17 (8.8)
|
DISCUSSION
The current study aimed to evaluate the epidemiological profile of patients treated
for vertigo and their postrehabilitation outcomes. This assessment was performed by
evaluating demographic data, such as sex, age and the cause, crossing the data and
evaluating each etiology, as we also sought to evaluate the main etiologies. We observed
that the sample was mostly composed of female patients, with an average age over 50
years, and that 99% of the patients showed improvement, 58% of whom, after the first
session.
When comparing this with the age profile found in the research, a study[4] states that 15 to 20% of the adult population is affected by vertigo and dizziness.
The predominance of female subjects is in agreement with other studies,[21]
[22] which report that women seek medical care more and that metabolic and hormonal changes
in women may influence the greater occurrence of vestibular disorders. When analyzing
the various causes of vertigo, BPPV is the most prevalent,[23] being the etiology responsible for 20 to 53% of patients referred to specialized
clinics.[24] These values found in the literature are similar to those of the present study,
with BPPV being the cause responsible for 55.9% of the cases.
In addition, the presence of comorbidities or associated symptoms is important in
relation to vertigo, with tinnitus being closely related, as already demonstrated
by a Brazilian study,[25] which analyzed patients with an average age of 64 years, in which 46% presented
vertigo and concomitant tinnitus, representing a value slightly higher than the percentage
found in the present study (30.8%). In addition, when restricting the tinnitus research
to the elderly population, another Brazilian study[26] which analyzed subjects with an average age of 73.86 years found the presence of
tinnitus in 62% of the elderly people with vertigo.
When analyzing the psychiatric profile of the present study, 29.2% presented depression
or anxiety. This data corresponds to that found in the literature: in a study from
São Paulo,[9] 29.5% of the elderly subjects analyzed presented symptoms of generalized anxiety
disorder. Vertigo complicated by psychological problems is still a complex issue,
and research[27] addresses a relationship of overlapping pathways in the central nervous system that
transmit emotional and vestibular information. Depression is related to the formation
of negative emotions, and this can worsen after repeated attacks of vertigo, which
cause physical discomfort and affect the patient's quality of life.[28]
In the current study, 20.5% of the patients presented SAH, and 7.7%, DM2, which corroborates
studies that state that vestibular dysfunctions have more than 1 associated clinical
alteration.[29]
[30] Studies[31]
[32] state that the presence of SAH brings a risk of recurrence of BPPV, due to vascular
damage that leads to labyrinthine ischemia and detachment of the otoconia. Additionally,
7.7% of the patients in the current study presented hypovitaminosis D, and a randomized
study[33] conducted between 2013 and 2017 showed that vitamin D supplementation may help prevent
BPPV attacks.
The majority (99%) of the patients in the present study improved after treatment with
vestibular rehabilitation exercises, confirming studies[32]
[33]
[34] that demonstrate increased functionality and improved quality of life. It cannot
be stated that these patients who improved were in fact those with BPPV, since a general
analysis of the data was performed, without a specific focus on any etiology. Vestibular
rehabilitation exercises can be performed in several ways, as mentioned in the introduction,
depending on the cause.[19] For causes such as neuritis, hypofunction, and vestibular migraine, exercises with
platforms, vibrotactile repositioning, virtual reality, and neuromodulation are performed.[35]
[36] When the etiology is BPPV, specific maneuvers are used, such as Epley and Semont
for the posterior canal or Lempert for the lateral canal.[35]
[36] Of these improvements, 58% occurred after the first treatment session and 23.3%,
in the second session, corroborating studies[37]
[38]
[39] that showed that the degree of improvement varies among patients. This improvement
in symptoms after performing the maneuvers confirms that the stimuli to the otoconia
were removed and body balance was restored, which are the objectives of vestibular
rehabilitation exercises.[37]
[38]
[40]
The present study had limitations due to the use of secondary data obtained from medical
records, which restricted the researchers to the information available and recorded
at the time of care. In addition, it was not possible to perform more in-depth cross-referencing
among the variables due to the lack of standardization or incomplete data, together
with the limited time to write the current work.
For future research, we suggest conducting studies in which psychiatric factors and
stroke with vertigo symptoms are evaluated. Furthermore, research can be performed
to better understand the association between tinnitus and vertigo, as they are commonly
associated symptoms, aiming for better therapy and potential means of prevention.
We conclude that the population in the southern region of Santa Catarina over 50 years
of age is more affected by vertigo, mainly women, and they present associations with
tinnitus, depression, and anxiety. The main cause found was BPPV, and most of the
patients improved immediately after the first vestibular rehabilitation session.
Bibliographical Record
Emanuela Hannoff Pilon, Vitor Benincá-Fernandes, Letícia Fernandes, Karina Rossa,
Tatiana Pizzolotto Bruch. Profile and postrehabilitation outcome of patients with
vertigo in a clinic in Southern Santa Catarina. Arq Neuropsiquiatr 2025; 83: s00451811175.
DOI: 10.1055/s-0045-1811175
