Resumen
Introducción: El vértigo y el mareo son síntomas frecuentes en la práctica clínica y generan un creciente interés debido a los altos costos asociados para los sistemas de salud a nivel mundial. Estos síntomas tienen un impacto significativo en el funcionamiento de las personas, aumentan el riesgo de caídas y están vinculados a diversas comorbilidades. Propuesta: Este estudio presenta información sobre la prevalencia de vértigo y mareo en Europa, Estados Unidos y Sudamérica, y propone una serie de recomendaciones específicas para abordar estas problemáticas en el contexto de Chile. Argumentación: Considerando el modelo de salud chileno y las estrategias del programa de resolutividad en atención primaria, se plantean sugerencias útiles para profesionales de la salud y médicos familiares. Estas recomendaciones incorporan las directrices de la Sociedad Bárány, así como experiencias y estrategias desarrolladas en Europa y Estados Unidos. Conclusiones: Las propuestas subrayan la importancia de capacitar a los profesionales de atención primaria en el uso del algoritmo TiTrATE y el protocolo HINTS, mejorar la infraestructura y los equipos para la evaluación y rehabilitación vestibular, establecer un lenguaje común entre clínicos, académicos e investigadores en el ámbito de los trastornos vestibulares, y desarrollar un plan básico de formación en medicina vestibular.
Citas
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
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