Keywords
dizziness
public health
vertigo management in Chile
vertigo
mareo
salud publica
manejo del vertigo en Chile
How to Cite
Abstract
Introduction: Vertigo and dizziness are common symptoms in clinical practice and have garnered increasing interest due to the significant costs they impose on healthcare systems worldwide. These symptoms have a substantial impact on individuals' functionality, increase the risk of falls, and are associated with various comorbidities. Proposal: This study provides information on the prevalence of vertigo and dizziness in Europe, the United States, and South America, and proposes a series of specific recommendations to address these issues within the context of Chile. Argumentation: Taking into account the Chilean healthcare model and the strategies of the primary care resolutivity program, practical suggestions are presented for healthcare professionals and family physicians. These recommendations incorporate the guidelines of the Bárány Society, as well as experiences and strategies developed in Europe and the United States. Conclusions: The proposals emphasize the importance of training primary care professionals in the use of the TiTrATE algorithm and the HINTS protocol, improving infrastructure and equipment for vestibular evaluation and rehabilitation, establishing a common language among clinicians, academics, and researchers regarding vestibular disorders, and developing a basic training plan in vestibular medicine.
References
Aedo-Sanchez, C., Riquelme-Contreras, P., Henríquez, F., & Aguilar-Vidal, E. (2024). Vestibular dysfunction and its association with cognitive impairment and dementia. Frontiers in Neuroscience, 18, 1304810. https://doi.org/10.3389/FNINS.2024.1304810/BIBTEX
Anson, E., Pineault, K., Bair, W., Studenski, S., & Agrawal, Y. (2019). Reduced vestibular function is associated with longer, slower steps in healthy adults during normal speed walking. Gait & Posture, 68, 340. https://doi.org/10.1016/J.GAITPOST.2018.12.016
Aranís J, C., Rioseco D, F., Fuentes L, N., & Fernández G, R. (2015). Vestibular pathology and its association with metabolic disease. Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello, 75(2), 114–121. https://doi.org/10.4067/S0718-48162015000200005
Atenas, T. L., Sabbagh, F. B., Grau, M. F. A., Alvarez, C. M., & Leal, J. R. (2017). Realidad de la Investigación en Salud en Chile: participación de los Médicos en el Fondo Nacional de Investigación (FONIS) en la última década. ARS MEDICA Revista de Ciencias Médicas, 42(2), 76–80. https://doi.org/10.11565/arsmed.v42i2.933
Bisdorff, A., Von Brevern, M., Lempert, T., Newman-Toker, D. E., Bertholon, P., Bronstein, A., Kingma, H., Antonio Lopez Escamez, J., Magnusson, M., Minor, L. B., As Pérez, N., Perrin, P., Suzuki, M., Waterston, J., & Yagi, T. (2009). Classification of vestibular symptoms: Towards an international classification of vestibular disorders. Journal of Vestibular Research, 19(1–2), 1–13. https://doi.org/10.3233/VES-2009-0343
Bisdorff, A. R., Staab, J. P., & Newman-Toker, D. E. (2015). Overview of the International Classification of Vestibular Disorders. Neurologic Clinics, 33(3), 541–550. https://doi.org/10.1016/J.NCL.2015.04.010
Bittar, R. S. M., Oiticica, J., Bottino, M. A., Ganança, F. F., & Dimitrov, R. (2013). Population epidemiological study on the prevalence of dizziness in the city of São Paulo. Brazilian Journal of Otorhinolaryngology (English Edition), 79(6), 688–698. https://doi.org/10.5935/1808-8694.20130127
Bronstein, A. M., Golding, J. F., Gresty, M. A., Mandalà, M., Nuti, D., Shetye, A., & Silove, Y. (2010). The social impact of dizziness in London and Siena. Journal of Neurology, 257(2), 183–190. https://doi.org/10.1007/S00415-009-5287-Z
Carnevale, C., Muñoz-Proto, F., Rama-López, J., Ferrán-de la Cierva, L., Rodríguez-Villalba, R., Sarría-Echegaray, P., Mas-Mercant, S., & Tomás-Barberán, M. (2014). [Management of benign paroxysmal positional vertigo in first care centers]. Semergen, 40(5), 254–260. https://doi.org/10.1016/J.SEMERG.2014.01.001
Castro, D. L., & Braga, P. (2013). Mareo y/o vértigo como motivo de consulta en la policlínica neurológica: estudio descriptivo. Revista Médica Del Uruguay, 29(4), 208–218. http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-03902013000400002&lng=es&nrm=iso&tlng=es
Crespo, C. F. (2018). Chile: nuevos desafíos sanitarios e institucionales en un país en transición. Revista Panamericana de Salud Pública, 42. https://doi.org/10.26633/RPSP.2018.137
Dietzek, M., Finn, S., Karvouniari, P., Zeller, M. A., Klingner, C. M., Guntinas-Lichius, O., Witte, O. W., & Axer, H. (2018). In Older Patients Treated for Dizziness and Vertigo in Multimodal Rehabilitation Somatic Deficits Prevail While Anxiety Plays a Minor Role Compared to Young and Middle Aged Patients. Frontiers in Aging Neuroscience, 10, 410691. https://doi.org/10.3389/FNAGI.2018.00345/BIBTEX
Domínguez-Durán, E., Mármol-Szombathy, I., Palmero-Olmo, E., Nogales-Nieves, A., López-Urbano, M. J., Palomo-Sánchez, A., Alarcón-Balanza, F., Ruiz-de Arcos, M., Bullón-Fernández, B., Valle-Martín, F., Mora-Quintero, A., Poyatos-Poyatos, B., Manjón-Collado, M. T., & Sánchez-Gómez, S. (2021). Epidemiology of balance disorders in primary care. Acta Otorrinolaringologica Espanola, 72(1), 11–20. https://doi.org/10.1016/J.OTORRI.2019.12.006
Edlow, J. A., Carpenter, C., Akhter, M., Khoujah, D., Marcolini, E., Meurer, W. J., Morrill, D., Naples, J. G., Ohle, R., Omron, R., Sharif, S., Siket, M., Upadhye, S., e Silva, L. O. J., Sundberg, E., Tartt, K., Vanni, S., Newman-Toker, D. E., & Bellolio, F. (2023). Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 30(5), 442–486. https://doi.org/10.1111/ACEM.14728
Edlow, J. A., Gurley, K. L., & Newman-Toker, D. E. (2018). A New Diagnostic Approach to the Adult Patient with Acute Dizziness. The Journal of Emergency Medicine, 54(4), 469–483. https://doi.org/10.1016/J.JEMERMED.2017.12.024
Franse, C. B., Rietjens, J. A. C., Burdorf, A., Van Grieken, A., Korfage, I. J., Van Der Heide, A., Mattace Raso, F., Van Beeck, E., & Raat, H. (2017). A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries. BMJ Open, 7(6). https://doi.org/10.1136/BMJOPEN-2017-015827
Guerra-Jiménez, G., Arenas Rodríguez, A., Falcón González, J. C., Pérez Plasencia, D., & Ramos Macías, Á. (2017). Epidemiology of vestibular disorders in the otoneurology unit. Acta Otorrinolaringologica Espanola, 68(6), 317–322. https://doi.org/10.1016/J.OTORRI.2017.01.007
Guo, J., Wang, J., Liang, P., Tian, E., Liu, D., Guo, Z., Chen, J., Zhang, Y., Zhou, Z., Kong, W., Crans, D. C., Lu, Y., & Zhang, S. (2024). Vestibular dysfunction leads to cognitive impairments: State of knowledge in the field and clinical perspectives (Review). International Journal of Molecular Medicine, 53(4). https://doi.org/10.3892/IJMM.2024.5360
Jönsson, R., Sixt, E., Landahl, S., & Rosenhall, U. (2004). Prevalence of dizziness and vertigo in an urban elderly population. Journal of Vestibular Research, 14(1), 47–52. https://doi.org/10.3233/VES-2004-14105
Kattah, J. C. (2018). Use of HINTS in the acute vestibular syndrome. An Overview. Stroke and Vascular Neurology, 3(4), 190. https://doi.org/10.1136/SVN-2018-000160
Kerber, K. A., Callaghan, B. C., Telian, S. A., Meurer, W. J., Skolarus, L. E., Carender, W., & Burke, J. F. (2017). Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. American Journal of Medicine, 130(12), 1465.e1-1465.e9. https://doi.org/10.1016/j.amjmed.2017.05.048
Luengo, M. X. (2012). Chile: la buena salud de la investigación en salud. Revista Chilena de Salud Pública, 16(3), 208–209. https://revistasaludpublica.uchile.cl/index.php/RCSP/article/view/23124
Marcotti F., A., Lavanderos O., D., Inostroza M., N., Lizana L., I., & Saavedra B., Y. (2021). Impacto de la autopercepción de dificultad vestibular en la calidad de vida de adultos sin patología otoneurológica diagnosticada. Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello, 81(4), 531–539. https://doi.org/10.4067/S0718-48162021000400531
Martins, T. F., Mancini, P. C., de Souza, L. de M., & Santos, J. N. (2017). Prevalence of dizziness in the population of Minas Gerais, Brazil, and its association with demographic and socioeconomic characteristics and health status. Brazilian Journal of Otorhinolaryngology (English Edition), 83(1), 29–37. https://doi.org/10.1016/J.BJORL.2016.01.015
Matthews, J. C., Agrawal, Y., Qian, Z. J., & Wei, E. X. (2024). Healthcare Utilization Among Adults With Vestibular Vertigo in the United States. Ear & Hearing. https://doi.org/10.1097/AUD.0000000000001487
Meldrum, D., Burrows, L., Cakrt, O., Kerkeni, H., Lopez, C., Tjernstrom, F., Vereeck, L., Zur, O., & Jahn, K. (2020). Vestibular rehabilitation in Europe: a survey of clinical and research practice. Journal of Neurology, 267(Suppl 1), 24. https://doi.org/10.1007/S00415-020-10228-4
Min Youn, G., Shah, J. P., Agrawal, Y., & Wei, E. X. (2023). Vestibular Vertigo and Disparities in Healthcare Access Among Adults in the United States. Ear and Hearing, 44(5), 1029–1035. https://doi.org/10.1097/AUD.0000000000001344
Mir, N., Trilla, A., Quintó, L. L., Molinero, M., & Asenjo, M. (2002). [Is there a place for otorhinolaryngology in primary care? Analysis of different areas]. Acta Otorrinolaringologica Espanola, 53(7), 495–501. https://doi.org/10.1016/S0001-6519(02)78341-6
Moore, M., Gould, P., & Keary, B. S. (2003). Global urbanization and impact on health. International Journal of Hygiene and Environmental Health, 206(4–5), 269–278. https://doi.org/10.1078/1438-4639-00223
Neuhauser, H. K. (2016). The epidemiology of dizziness and vertigo. Handbook of Clinical Neurology, 137, 67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4
Neuhauser, H. K., & Lempert, T. (2009). Vertigo: epidemiologic aspects. Seminars in Neurology, 29(5), 473–481. https://doi.org/10.1055/S-0029-1241043
Newman-Toker, D. E., Camargo, C. A., Hsieh, Y. H., Pelletier, A. J., & Edlow, J. A. (2009). Disconnect between charted vestibular diagnoses and emergency department management decisions: a cross-sectional analysis from a nationally representative sample. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16(10), 970–977. https://doi.org/10.1111/J.1553-2712.2009.00523.X
Newman-Toker, D. E., & Edlow, J. A. (2015). TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurologic Clinics, 33(3), 577–599. https://doi.org/10.1016/J.NCL.2015.04.011
Ojeda Toro, G. D., Ariza Aguilar, L. O., Montaña, D., Parra, J. F., Ojeda Toro, G. D., Ariza Aguilar, L. O., Montaña, D., & Parra, J. F. (2022). Enfoque del mareo y vértigo en el servicio de urgencias. Universitas Medica, 63(1), 115–123. https://doi.org/10.11144/JAVERIANA.UMED63-1.EMVS
Penger, M., Strobl, R., & Grill, E. (2017). Country-specific and individual determinants of dizziness in Europe: results from the Survey of Health Ageing and Retirement in Europe (SHARE). Public Health, 149, 1–10. https://doi.org/10.1016/J.PUHE.2017.04.002
Pérez, P., Manrique, C., Álvarez, M. J., Aldama, P., Álvarez, J. C., Luisa Fernández, M., & Méndez, J. C. (2008). Evaluation of Benign Paroxysmal Positional Vertigo in Primary Health-Care and First Level Specialist Care. Acta Otorrinolaringologica (English Edition), 59(6), 277–282. https://doi.org/10.1016/S2173-5735(08)70238-2
Reider, L., Falvey, J. R., Okoye, S. M., Wolff, J. L., & Levy, J. F. (2024). Cost of U.S emergency department and inpatient visits for fall injuries in older adults. Injury, 55(2). https://doi.org/10.1016/j.injury.2023.111199
Ruthberg, J. S., Rasendran, C., Kocharyan, A., Mowry, S. E., & Otteson, T. D. (2021). The economic burden of vertigo and dizziness in the United States. Journal of Vestibular Research : Equilibrium & Orientation, 31(2), 81–90. https://doi.org/10.3233/VES-201531
Saber Tehrani, A. S., Coughlan, D., Hsieh, Y. H., Mantokoudis, G., Korley, F. K., Kerber, K. A., Frick, K. D., & Newman-Toker, D. E. (2013). Rising annual costs of dizziness presentations to U.S. emergency departments. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 20(7), 689–696. https://doi.org/10.1111/ACEM.12168
Staab, J. P., Eckhardt-Henn, A., Horii, A., Jacob, R., Strupp, M., Brandt, T., & Bronstein, A. (2017). Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the classification of vestibular disorders of the barany society. Journal of Vestibular Research: Equilibrium and Orientation, 27(4), 191–208. https://doi.org/10.3233/VES-170622
Stam, H., van Vugt, V. A., Twisk, J. W. R., Finne-Soveri, H., Garms-Homolová, V., Declercq, A., Jónsson, P. V., Onder, G., van der Roest, H. G., van Hout, H., & Maarsingh, O. R. (2020). The Prevalence and Persistence of Dizziness in Older European Home Care Recipients: A Prospective Cohort Study. Journal of the American Medical Directors Association, 21(3), 338-343.e1. https://doi.org/10.1016/J.JAMDA.2019.09.008
Taybeh, E. O., & Naser, A. Y. (2023). Hospital Admission Profile Related to Inner Ear Diseases in England and Wales. Healthcare, 11(10). https://doi.org/10.3390/HEALTHCARE11101457
Torres-Quevedo, R. (2016). Déficit de médicos especialistas en las regiones y en el sistema público. Revista Chilena de Cirugía, 68(4), 279–280. https://doi.org/10.1016/J.RCHIC.2016.05.001
Van De Berg, R., Murdin, L., Whitney, S. L., Holmberg, J., & Bisdorff, A. (2022). Curriculum for Vestibular Medicine (VestMed) proposed by the Bárány Society. Journal of Vestibular Research : Equilibrium & Orientation, 32(2), 89–98. https://doi.org/10.3233/VES-210095
Zwergal, A., Brandt, T., Magnusson, M., & Kennard, C. (2016). DIZZYNET--a European network initiative for vertigo and balance research: visions and aims. Journal of Neurology, 263 Suppl 1, 2–9. https://doi.org/10.1007/S00415-015-7912-3
Zwergal, A., van de Berg, R., & Dieterich, M. (2020). DIZZYNET 2020: basic and clinical vestibular research united. Journal of Neurology, 267(Suppl 1), 1. https://doi.org/10.1007/S00415-020-10317-4
##plugins.facebook.comentarios##
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2025 Jorge Colipí Sáez, Alexis Gonzalez Burboa