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.