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ENT-VSL-12 Data Details

ENT-VSL-12 Increase the proportion of adults with moderate to severe balance or dizziness problems who have seen or been referred to a health care specialist for evaluation or treatment

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Health Interview Survey (NHIS); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
percent (age adjusted—see Comments)
Baseline (Year)
65.4 (2008)
Target
72.0
Target-Setting Method
10 percent improvement
Numerator
Number of persons aged 18 years and over for whom dizziness, vertigo, or imbalance (unsteadiness) is a moderate, big, or very big problem and who have been seen by, or referred to, a Health Care specialist such as an ENT (Ear, Nose, and Throat physician), an audiologist, a neurologist, a cardiologist, an internist, a podiatrist (foot doctor), a physical therapist, an occupational therapist, or other specialist
Denominator
Number of persons aged 18 years and over for whom dizziness, vertigo, or imbalance (unsteadiness) is a moderate, big, or very big problem
Questions Used to Obtain the National Baseline Data

From the 2008 National Health Interview Survey, Balance and Dizziness Supplement:

[NUMERATOR AND DENOMINATOR:]

DURING THE PAST 12 MONTHS, have you had a problem with dizziness or balance? Do not include times when drinking alcohol.

  1. Yes
  2. No

This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.

  • A spinning or vertigo sensation, a rocking of yourself or your surroundings
    1. Yes
    2. No
  • A floating, spacey, or tilting sensation
    1. Yes
    2. No
  • Feeling lightheaded, without a sense of motion
    1. Yes
    2. No
  • Feeling as if you are going to pass out or faint
    1. Yes
    2. No
  • Blurring of your vision when you move your head
    1. Yes
    2. No
  • Feeling off-balance or unsteady
    1. Yes
    2. No

DURING THE PAST 12 MONTHS, which ONE of these feelings of dizziness or balance problems bothered you the most? [Read categories below.]

  1. Feeling a sense of spinning
  2. A floating or spacey feeling
  3. Feeling lightheaded
  4. Feeling like you are about to pass out
  5. Blurred vision
  6. Unsteadiness

DURING THE PAST 12 MONTHS, how much of a problem was your dizziness or balance condition?

  1. No problem
  2. A small problem
  3. A moderate problem
  4. A big problem
  5. A very big problem

[NUMERATOR:]

These next questions are about seeing a doctor or other health care professional and if "yes", what type of doctor/health care professional was seen.

Have you ever seen a doctor or other health care professional, except for in the emergency room, about your most bothersome dizziness or balance problem?

  1. Yes
  2. No

Which of the following types of doctors or health care professionals have you seen about your most bothersome dizziness or balance problem? Please say Yes or No to each.

  • Cardiologist or doctor of internal medicine
    1. Yes
    2. No
  • Ear, nose, and throat doctor
    1. Yes
    2. No
  • Neurologist
    1. Yes
    2. No
  • Eye doctor, optometrist, or ophthalmologist
    1. Yes
    2. No
  • Podiatrist or foot doctor
    1. Yes
    2. No
  • Psychiatrist, psychologist or social worker
    1. Yes
    2. No
  • Occupational therapist, physical therapist, or rehabilitation specialist
    1. Yes
    2. No
  • Radiologist or technician for MRI, CAT scan or ultrasound
    1. Yes
    2. No
Data Collection Frequency
Periodic
Comparable Healthy People 2010 Objective
Not applicable
Methodology Notes

The numerator is calculated as the number of adults who responded: “yes” to (e) AND who answered (f) with an appropriate specialty (see listed responses) AND who also answered “yes” to (a) OR selected a condition in (b) AND who answered 3), 4) or 5) to (d). The denominator includes all the subjects who responded: “yes” to (a) OR selected a condition in (b) AND who answered 3), 4) or 5) to (d). By the number of adults, we mean the weighted sample number estimated for the U.S. population. The percent that is measured and tracked is calculated by dividing the numerator by the denominator.

Vestibular disorders, which encompass dizziness and balance problems, occur as significant problems (i.e., judged to be “moderate”, “big”, or “very big” problems) in about 8.4 million U.S. adults, based on analyses of the 2008 Balance and Dizziness Supplement to the National Health Interview Survey. Vestibular impairment is an underlying cause in as many of 45% of patients complaining of “dizziness”. These distressing symptoms may be accompanied by nausea, vomiting, and a ringing or fullness sensation in the ears. Many people with a vestibular disorder can be treated effectively; however the diagnosis is frequently missed, particularly in older patients. In one recent study of patients presenting with dizziness, more than half with vestibular causes reported non-vestibular diagnoses. Whether the condition results from an external event like traumatic injury, or some other cause, patients with vestibular impairment often experience a serious decrease in the quality of their lives. Not all the complaints of dizziness, vertigo, or disequilibrium (imbalance or unsteadiness) are symptoms that result from vestibular disorders; some dizziness and balance problems are the result of neurologic, vascular, psychological, and even orthopedic pathology. As such, it is not always clear which specialty is appropriate for referral. In this age of cost awareness and effectiveness, the primary care physician must make important decisions as to the appropriateness and cost-effectiveness of diagnostic procedures and referrals to specialists.

Currently, 50% of patients seen in the primary care setting receive no diagnosis for their complaints of dizziness, yet 70% receive a prescription for meclizine, (Antivert). Meclizine has not been demonstrated to be effective or appropriate in the treatment of chronic disequilibrium, dizziness or imbalance. It is occasionally effective in reducing nausea associated with vertigo/spinning in some forms of chronic vertiginous disease, however, it is not curative in any way, and in fact interferes with the natural recovery process often worsening matters further. At one time or other, most people have experienced dizziness, one of the vaguest complaints a therapist faces in practice because what each person calls dizziness differs greatly. Some describe it as poor balance, lightheadedness, wooziness, or spinning, while others may say they feel as if they are about to faint. Trying to put into words what they are feeling can be very difficult. All of this leads to the word dizziness being nearly useless as a one-word description.

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-44, 45-64, 65-74, 75+
  • Sex: 18-44, 45-64, 65-74, 75+
  • Race/Ethnicity: 18-44, 45-64, 65-74, 75+
  • Educational Attainment: 25-44, 45-64, 65-74, 75+
  • Family Income: 18-44, 45-64, 65-74, 75+
  • Family Type: 18-44, 45-64, 65-74, 75+
  • Country of Birth: 18-44, 45-64, 65-74, 75+
  • Disability Status: 18-44, 45-64, 65-74, 75+
  • Geographic Location: 18-44, 45-64, 65-74, 75+
  • Health Insurance Status: 18-44, 45-64
  • Marital Status: 18-44, 45-64, 65-74, 75+
Caveats and Limitations
To properly care for patients with dizziness, physicians or other Health Care providers need to be able to differentiate the four types of symptoms — vertigo, disequilibrium (unsteadiness, imbalance), near-syncope (lightheadedness), and nonspecific dizziness,3 any of which can lead to withdrawal from valued occupations. A general physical examination of the ears, head, and neck should be done with special emphasis on tests of balance function. Additional testing is often recommended such as hearing tests, CT scans, MRI scans, electronystagmography (ENG), and blood tests. ENG is a technique to measure involuntary eye movements (nystagmus) that are related to balance disorders. In some situations, referral to an ear specialist (otolaryngologist), audiologist, or neurologist may also be necessary. In addition, consultations with a cardiologist, psychiatrist, and general internist are often indicated. Balance disorders can be unpredictable. Depending on the cause, the symptoms can occur at any time, even after long periods of absence of symptoms (remission). It is important, therefore, to take proper precautions in order to avoid accidents that could be caused by a balance disorder.

References

Additional resources about the objective.

  1. Bhattacharyya N, Baugh RF, Orvidas L, et al. 2008. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 139(5 Suppl 4):S47–8
  2. Cohen HS. 2006. Disability and rehabilitation in the dizzy patient. Curr Opin Neurol. 19(1):49–54.
  3. Konrad HR, Girardi M, Helfert R. 1999. Balance and aging. Laryngoscope. 109:1454–1460.