Comolli L, Goeldlin M, Gaschen J, Kammer C, Sauter T C, Caversaccio M D, Kalla R, Fischer U, Mantokoudis G
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz.
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz.
HNO. 2020 Oct;68(10):763-772. doi: 10.1007/s00106-020-00857-6.
Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed.
In this cross-sectional study, we investigated the spectrum of vertigo and dizziness in a tertiary ear, nose, and throat (ENT) emergency department (ED). Furthermore, we investigated the attendant symptoms, clinical signs, and the diagnostic tests performed.
We screened all ED reports from 01/2013 to 12/2013 for adult patients with vestibular symptoms referred to the ENT department.
In total, we found 2596 cases with reported vestibular symptoms in the ED as a main or accompanying complaint. Of these, 286 were referred to the ENT specialist directly (n = 98) or via other major medical specialties (n = 188). Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n = 46, 16.1%), followed by vestibular neuritis (n = 44, 15.4%), otitis media (n = 20, 7%), and 9 patients (3.1%) had an ischemic stroke or a transient ischemic attack. In 70 (24.5%) cases, dizziness was not further specified.
BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.
尽管前庭症状是寻求紧急医疗帮助的最常见原因之一，但许多患者仍未得到诊断。
在这项横断面研究中，我们调查了三级耳鼻喉科（ENT）急诊科（ED）中眩晕和头晕的范围。此外，我们还调查了伴随症状、临床体征以及所进行的诊断测试。
我们筛查了2013年1月至2013年12月期间转诊至耳鼻喉科的有前庭症状的成年患者的所有急诊报告。
我们共发现2596例在急诊中报告有前庭症状作为主要或伴随主诉的病例。其中，286例直接转诊至耳鼻喉科专家（n = 98）或通过其他主要医学专科转诊（n = 188）。良性阵发性位置性眩晕（BPPV）是我们研究中最常见的诊断（n = 46，16.1%），其次是前庭神经炎（n = 44，15.4%）、中耳炎（n = 20，7%），9例患者（3.1%）患有缺血性中风或短暂性脑缺血发作。在70例（24.5%）病例中，头晕未进一步明确诊断。
BPPV是急诊中最常见的诊断；然而，医生需要更精确地记录眼球震颤并系统地进行诊断测试，以便做出准确诊断。为避免误诊，急诊医生和耳鼻喉科专家应能够识别急性前庭综合征患者的中枢体征。每四分之一的患者未得到明确诊断。对头晕患者的急诊检查工作需要进一步改进。
