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Vestibular Dysfunction Prevalence in the US

Dr. Danielle Gross, PT, DPT

When people ask me what I do, and I reply, “I am a physical therapist who specializes in (and loves) Vestibular Therapy”, I usually get a puzzled look. Some will politely smile and nod along, while others ask “vesti-what?”. I try to explain that there are ways we can treat dizziness and vertigo, and almost every time I hear “Oh! I know someone who had that!”. This got me wondering… what exactly is the prevalence of vestibular dysfunction; how often should we expect to see some sort of vestibular issue in patients as medical professionals?

After some digging, I came across this great study published in 2009: “Disorders of Balance and Vestibular Function in US Adults” authored by Yuri Agrawal, MD; John P. Carey, MD; Charles C. Della Santina MD, PhD; Michael C. Schubery PhD; and Lloyd B. Minor, MD. The authors of the study used The National Health and Nutrition Examination Survey (NHANES) from 2001-2004 which included over 5000 individuals to estimate the prevalence of vestibular dysfunction among those in the United States 40 years and older. The NHANES “is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.” In this case, the NHANES included a balance questionnaire as well as balance testing consisting of a “modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces”.1 The balance test was measured as pass/fail, failure being defined as subjects opening their eyes, moving their arms or feet to achieve stability, or falling/requiring tester intervention during the required 30 second interval for each condition. One retest was given to the participant if they failed a condition. For this study, the authors only looked at those who failed condition 4, which requires the participant to stand on a compliant surface with their eyes closed. Condition 4 specifically measures vestibular function by eliminating sensory input from the other systems that contribute to balance: the visual system, and proprioception input.

There are a few reasons why I really loved this article, and why I think it’s great to share. At first, I was a little wary of how vestibular dysfunction was so broadly defined and tested. Then I realized how truly broad vestibular dysfunction can be! BPPV, unilateral hypofunctions, vestibular migraines, Meniere’s Disease, vestibular neuritis, and so much more… A simple pass/fail test of the vestibular system with eyes closed and on a compliant surface is a great way to gage for any dysfunction. This test accounts for the function of all vestibular components including the semicircular canals and the otolith organs. In comparison, a VNG only looks at the structures innervated by the superior vestibular nerve, and neglects posterior canal and saccule function. I also really liked that the study looked at a large sample size (n=5086). This puts more strength behind their results, and the conclusions drawn from the results. Finally, I really like how this article looks at factors that raise the risk of vestibular dysfunction, and how they directly relate to an increased risk of falling.

So, what was the result of the study? What did they find? Let’s sum it up:

  1. “The prevalence of vestibular dysfunction in the US population aged 40 years and older from 2001-2004 was 35.4%.”1
  2. The prevalence of vestibular dysfunction increased markedly with age
    1. 85% of individuals age 80 and above had evidence of vestibular/balance dysfunction2
  3. The prevalence of vestibular dysfunction did not significantly differ by sex or among whites, black, and Mexican-Americans.1
  4. Higher prevalence rates of vestibular dysfunction were found in individuals with cardiovascular risk characteristics such as:1
    1. Heavy tobacco use (≥20 years)
    2. Hypertension
    3. Diabetes
      1. The odds of balance dysfunction were found to be 70% higher among individuals with diabetes mellitus2
  5. Individuals with vestibular dysfunction have significantly increased odds of hearing loss1
  6. Individuals with vestibular dysfunction were more likely to report having dizziness and a history of falls1
  7. Participants who tested with vestibular dysfunction, but were asymptomatic, had a nearly 8-fold risk of falling1

In 2014 Yuri Agrawal, Bryan K. Ward, and Lloyd B. Minor wrote another article: “Vestibular Dysfunction: Prevalence, impact and need for targeted treatment”. This article breaks down the prevalence of specific vestibular disorders including: BPPV, vestibular migraine, Meniere’s Disease, vestibular neuritis, and superior canal dehiscence. It also discusses the impact of vestibular disorders. Here are a few interesting points from the article:

  1. Individuals with vestibular vertigo in a study in Germany reported interruption of their daily activities, and the need for sick leave or medical consultation in 80% of subjects2
  2. In Italy and England, a Social Life and Work Impact of Dizziness questionnaire found that:2
    1. 27% of subjects with dizziness reported changing jobs
    2. 21% gave up work
    3. 50% reported reduced efficiency at work
    4. 57% reported a disruption in their social life
    5. 35% reported family difficulties
    6. 50% reported difficulty with travel
  3. Patients with vestibular disorders reporting to a neurotology clinic experienced greater than expected anxiety and depression distress. Patient’s also report cognitive impairment or “brain fog”2
  4. 1 in 3 community-dwelling adults aged over 65 fall each year2
  5. 10% of falls result in major injuries such as hip fractures2
  6. Falls with injury increase the risk of nursing home placement 10-fold2
  7. The cost of falls in the US are estimated to exceed $20 billion annually2

Agrawal et al. (2014) took their 2009 article one step further. They “sought to further characterize the changes in vestibular physiologic function associated with aging”2. They evaluated if age related deficits occur symmetrically or selectively across the 5 vestibular organs (3 semicircular canals, 2 otolith organs). They found “that vestibular function declined asymmetrically across the vestibular end-organs: 80-90% of individuals age 70 and above had evidence of semicircular canal dysfunction, whereas only 50% of participants had abnormal saccular function and 20% had utricular impairment”.2

Both articles demonstrate that vestibular dysfunction is very prevalent and has a significant impact on a person’s overall health and quality of life. They show the importance of proper testing/diagnosis and treatment to help the patient manage symptoms and prevent falls. So, if the prevalence for vestibular dysfunction is so high, then why are so many people unaware of what it is? Why are people shocked to find out that there is treatment and there are ways to manage the dysfunction? There are already many efforts for raising community awareness and opportunities for patient education, but we should keep pushing for more. Check out the resources and ways to raises awareness at Vestibular Disorders Association (www.Vestibular.org). Help make a difference!

References:

  1. Agrawal Y, Carey JP, et al. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Arch Intern Med. 2009;169(10):938–944.
  2. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of Balance and Vestibular Function in US Adults Data From the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009;169(10):938-944. doi:10.1001/archinternmed.2009.66
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