Database of 1216 patients with dizzines-vertigo referred for oculographic evaluation and caloric test
Abstract
Introduction and objective: Creation of a database to study otoneurological pathology in a population that underwent electro-oculography (EOG) with caloric testing (CT) at the ENT Department of a tertiary care hospital within the Public Health System. Presentation of the general characteristics of the sample investigated. Material and methods: Observational, descriptive, and ambispective cohort study of 1,216 patients. Recording of data from EOG examinations (2001–2022) and retrospective evaluation of each patient's clinical evolution until 2024. The examination methodology applied is detailed. Results: The variables selected to determine the epidemiology, clinical presentation, examination, progression, and diagnosis of these patients are described. Women predominate in the population, with a mean age of 47 years and an average follow-up of 6.5 years. The most common presenting symptom is vertigo, with episodic vestibular syndrome prevailing. Sixty-eight per cent of patients associated hearing loss with CP, which was pathological in 35 per cent of cases. The processes recorded are distributed across 37 diagnoses, of which only 38 per cent could be included in any of those covered by the current classification of the Bárány Society. Discussion/Conclusions: A fundamental problem in otoneurological pathology is the difficulty of establishing a nosological order that encompasses all patients. This general analysis highlights this complexity despite the publication of various consensus documents, which will need to be adapted in light of the findings of clinical research.
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Garrigues HP, Andres C, Arbaizar A, Cerdan C, Meneu V, Oltra JA, et al. Epidemiological aspects of vertigo in the general population of the Autonomic Region of Valencia, Spain. Acta Otolaryngol. 2008;128(1):43-7. https://doi.org/10.1080/00016480701387090. PMID: 17851953.
Domínguez-Durán E, Mármol-Szombathy I, Palmero-Olmo E, Nogales-Nieves A, López-Urbano MJ, Palomo-Sánchez A, et al. Epidemiology of balance disorders in primary care. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):11-20. https://doi.org/10.1016/j.otorri.2019.12.006. PMID: 32522341.
Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4. PMID: 27638063.
Wojtczak R, Narożny W, Kuczkowski J, Siebert J. Epidemiology of dizziness in northern Poland - The first Polish neurootologic survey of the general population. Ann Agric Environ Med. 2017;24(3):502-6. https://doi.org/10.5604/12321966.1228401. PMID: 28954498.
Bird JC, Beynon GJ, Prevost AT, Baguley DM. An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998;48(437):1828-32. PMID: 10198501. PMCID: PMC1313257.
Kroenke K, Hoffman RM, Einstadter D. How common are various causes of dizziness? A critical review. South Med J. 2000;93(2):160-7. https://doi.org/10.1097/00007611-200002000-00001. PMID: 10701780.
Jayarajan V, Rajenderkumar D. A survey of dizziness management in General Practice. J Laryngol Otol. 2003;117(8):599-604. https://doi.org/10.1258/002221503768199915. PMID: 12956912.
Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015;33(3):577-99. https://doi.org/10.1016/j.ncl.2015.04.011. PMID: 26231273. PMCID: PMC4522574.
Kaski D. Neurological update: dizziness. J Neurol. 2020;267(6):1864-9. https://doi.org/10.1007/s00415-020-09748-w. PMID: 32130499. PMCID: PMC7293664.
Strupp M, Brandt T. Diagnosis and treatment of vertigo and dizziness. Dtsch Arztebl Int. 2008;105(10):173-80. https://doi.org/10.3238/arztebl.2008.0173. PMID: 19629221. PMCID: PMC2696792.
van de Berg R, Rosengren S, Kingma H. Laboratory examinations for the vestibular system. Curr Opin Neurol. 2018;31(1):111-6. https://doi.org/10.1097/WCO.0000000000000526. PMID: 29189298.
Mobarek EM, Okdeh MB, Jamalelden YS. Dizziness: Approach to evaluation, assessment, and management. SAS J Med. 2022;8(2):90-9. https://doi.org/10.36347/sasjm.2022.v08i02.007.
Narayana Swamy S, Yuvaraj P, Pruthi N, Thennarasu K, Rajasekaran AK. Comprehensive Normative Data for Objective Vestibular Tests. Cureus. 2023;15(6):e40080. https://doi.org/10.7759/cureus.40080. PMID: 37292112. PMCID: PMC10243448.
Gofrit SG, Mayler Y, Eliashar R, Bdolah-Abram T, Ilan O, Gross M. The Association Between Vestibular Physical Examination, Vertigo Questionnaires, and the Electronystagmography in Patients With Vestibular Symptoms. Ann Otol Rhinol Laryngol. 2017;126(4):315-21. https://doi.org/10.1177/0003489417691298. PMID: 28290231.
Roland LT, Kallogjeri D, Sinks BC, Rauch SD, Shepard NT, White JA, et al. Utility of an Abbreviated Dizziness Questionnaire to Differentiate Between Causes of Vertigo and Guide Appropriate Referral: A Multicenter Prospective Blinded Study. Otol Neurotol. 2015;36(10):1687-94. https://doi.org/10.1097/MAO.0000000000000884. PMID: 26485598. PMCID: PMC4692465.
Domínguez-Durán E, Moreno-de-Jesús C, Prieto-Sánchez-de-Puerta L, Mármol-Szombathy I, Sánchez-Gómez S. Identifying Training, Diagnostic and Therapeutic Needs From a Comparison in the Distribution of Vestibular Disorders in Primary Care and in a Neurotology Unit. Front Neurol. 2020;11:605613. https://doi.org/10.3389/fneur.2020.605613. PMID: 33329367. PMCID: PMC7714908.
Strobl R, Grözinger M, Zwergal A, Huppert D, Filippopulos F, Grill E. A Set of Eight Key Questions Helps to Classify Common Vestibular Disorders-Results From the DizzyReg Patient Registry. Front Neurol. 2021;12:670944. https://doi.org/10.3389/fneur.2021.670944. PMID: 33995265. PMCID: PMC8116658.
Kaski D, Tarnutzer AA, Agrawal Y, Carey J, Cha YH, Eggers SD, et al. The International Classification of Vestibular Disorders: Achievements, challenges, and future directions. J Vestib Res. 2025;35(3):105-112. https://doi.org/10.1177/09574271251313803. PMID: 39973600. PMCID: PMC12231871.
Soto-Varela A, Arán-González I, López-Escámez JA, Morera-Pérez C, Oliva-Domínguez M, Pérez-Fernández N, et al. Clasificación de los vértigos periféricos de la Comisión de Otoneurología de la Sociedad Española de Otorrinolaringología: concordancia diagnóstica y actualización (versión 2, año 2011). Acta Otorrinolaringol Esp. 2012;63(2):125-31. https://doi.org/10.1016/j.otorri.2011.10.004. PMID: 22169589.
Shepard NT, Jacobson GP. The caloric irrigation test. Handb Clin Neurol. 2016;137:119-31. https://doi.org/10.1016/B978-0-444-63437-5.00009-1. PMID: 27638067.
Barin K. Interpretation and usefulness of caloric testing. En: Jacobson G, Shepard NT, eds. Balance Function Assessment and Management. 2nd ed. San Diego: Plural Publishing; 2015. p. 319-46.
British Society of Audiology. Recommended procedure: The caloric test (2010), Vestibular assessment - eye movement recordings (2015), Positioning tests (2016) [Internet]. 2016 [consultado 22 mar 2026]. Disponible en: https://www.thebsa.org.uk/guidance-and-resources/current-guidance/?subject=balance
Pérez-Vázquez P, Franco-Gutiérrez V. La prueba calórica. Revista ORL. 2018;9(3):193-213. https://doi.org/10.14201/orl.17699.
Sanz-Fernández R, Martín-Sanz E. Exploración otoneurológica. Interpretación de las pruebas vestibulares. 1ª ed. Barcelona: Amplifón Ibérica; 2016. 336 p.
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. https://doi.org/10.3233/VES-2009-0343. PMID: 19893191.
López-Gentili LI, Kremenchutzky M, Salgado P. Análisis estadístico de 1.300 pacientes con mareo-vértigo. Causas más frecuentes. Rev Neurol. 2003;36(5):417-20. PMID: 12640592.
Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36(1):30-5. https://doi.org/10.1016/j.anl.2008.03.006. PMID: 18486378.
Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neurol. 2012;3:169. https://doi.org/10.3389/fneur.2012.00169. PMID: 23226141. PMCID: PMC3508265.
Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system. Nat Rev Neurol. 2017;13(6):352-62. https://doi.org/10.1038/nrneurol.2017.58. PMID: 28429801.
Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020;267(8):2252-9. https://doi.org/10.1007/s00415-020-09831-2. PMID: 32300888.
Xing Y, Si L, Zhang W, Wang Y, Li K, Yang X. Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study. J Neurol. 2024;271(5):2446-57. https://doi.org/10.1007/s00415-024-12495-x. PMID: 39042149. PMCID: PMC11377546.
Shen Y, Liu W, Qi X. Dizziness in a tertiary neurological department: A cross-sectional study. Brain Behav. 2023;13(2):e2864. https://doi.org/10.1002/brb3.2864. PMID: 36582121. PMCID: PMC9927854.
Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular Disorders. Dtsch Arztebl Int. 2020;117(17):300-10. https://doi.org/10.3238/arztebl.2020.0300. PMID: 32530417. PMCID: PMC7335649.
Bisdorff A. Vestibular symptoms and history taking. Handb Clin Neurol. 2016;137:83-90. https://doi.org/10.1016/B978-0-444-63437-5.00006-6. PMID: 27638064. PMCID: PMC5214453.
van de Berg R, Kingma H. History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach. J Clin Med. 2021;10(24):5726. https://doi.org/10.3390/jcm10245726. PMID: 34945023. PMCID: PMC8703413.
Pérez-Fernández N, Ramos-Macías A. Recent Advances in the Diagnosis and Treatment of Vestibular Disorders. J Clin Med. 2023;12(16):5281. https://doi.org/10.3390/jcm12165281. PMID: 37629323. PMCID: PMC10455078.
Yardley L, Medina SM, Jurado CS, Morales TP, Martinez RA, Villegas HE. Relationship between physical and psychosocial dysfunction in Mexican patients with vertigo: a cross-cultural validation of the vertigo symptom scale. J Psychosom Res. 1999;46(1):63-74. https://doi.org/10.1016/S0022-3999(98)00056-7. PMID: 10088983.
Mègnigbêto CA, Sauvage JP, Launois R. Validation clinique d'une échelle du vertige: EEV (European Evaluation of Vertigo). Rev Laryngol Otol Rhinol (Bord). 2001;122(2):95-102. PMID: 11715268.
Zhao JG, Piccirillo JF, Spitznagel EL Jr, Kallogjeri D, Goebel JA. Predictive capability of historical data for diagnosis of dizziness. Otol Neurotol. 2011;32(2):284-90. https://doi.org/10.1097/MAO.0b013e318204aad3. PMID: 21178804. PMCID: PMC3543606.
Paredis S, van Stiphout L, Remmen E, Strupp M, Gerards MC, Kingma H, et al. DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy. Front Neurol. 2021;12:771650. https://doi.org/10.3389/fneur.2021.771650. PMID: 34867759. PMCID: PMC8633101.
Domínguez-Durán E, Mármol-Szombathy I, Palmero-Olmo E, Nogales-Nieves A, López-Urbano MJ, Palomo-Sánchez A, et al. Epidemiology of balance disorders in primary care. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):11-20. https://doi.org/10.1016/j.otorri.2019.12.006. PMID: 32522341.
Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4. PMID: 27638063.
Wojtczak R, Narożny W, Kuczkowski J, Siebert J. Epidemiology of dizziness in northern Poland - The first Polish neurootologic survey of the general population. Ann Agric Environ Med. 2017;24(3):502-6. https://doi.org/10.5604/12321966.1228401. PMID: 28954498.
Bird JC, Beynon GJ, Prevost AT, Baguley DM. An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998;48(437):1828-32. PMID: 10198501. PMCID: PMC1313257.
Kroenke K, Hoffman RM, Einstadter D. How common are various causes of dizziness? A critical review. South Med J. 2000;93(2):160-7. https://doi.org/10.1097/00007611-200002000-00001. PMID: 10701780.
Jayarajan V, Rajenderkumar D. A survey of dizziness management in General Practice. J Laryngol Otol. 2003;117(8):599-604. https://doi.org/10.1258/002221503768199915. PMID: 12956912.
Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin. 2015;33(3):577-99. https://doi.org/10.1016/j.ncl.2015.04.011. PMID: 26231273. PMCID: PMC4522574.
Kaski D. Neurological update: dizziness. J Neurol. 2020;267(6):1864-9. https://doi.org/10.1007/s00415-020-09748-w. PMID: 32130499. PMCID: PMC7293664.
Strupp M, Brandt T. Diagnosis and treatment of vertigo and dizziness. Dtsch Arztebl Int. 2008;105(10):173-80. https://doi.org/10.3238/arztebl.2008.0173. PMID: 19629221. PMCID: PMC2696792.
van de Berg R, Rosengren S, Kingma H. Laboratory examinations for the vestibular system. Curr Opin Neurol. 2018;31(1):111-6. https://doi.org/10.1097/WCO.0000000000000526. PMID: 29189298.
Mobarek EM, Okdeh MB, Jamalelden YS. Dizziness: Approach to evaluation, assessment, and management. SAS J Med. 2022;8(2):90-9. https://doi.org/10.36347/sasjm.2022.v08i02.007.
Narayana Swamy S, Yuvaraj P, Pruthi N, Thennarasu K, Rajasekaran AK. Comprehensive Normative Data for Objective Vestibular Tests. Cureus. 2023;15(6):e40080. https://doi.org/10.7759/cureus.40080. PMID: 37292112. PMCID: PMC10243448.
Gofrit SG, Mayler Y, Eliashar R, Bdolah-Abram T, Ilan O, Gross M. The Association Between Vestibular Physical Examination, Vertigo Questionnaires, and the Electronystagmography in Patients With Vestibular Symptoms. Ann Otol Rhinol Laryngol. 2017;126(4):315-21. https://doi.org/10.1177/0003489417691298. PMID: 28290231.
Roland LT, Kallogjeri D, Sinks BC, Rauch SD, Shepard NT, White JA, et al. Utility of an Abbreviated Dizziness Questionnaire to Differentiate Between Causes of Vertigo and Guide Appropriate Referral: A Multicenter Prospective Blinded Study. Otol Neurotol. 2015;36(10):1687-94. https://doi.org/10.1097/MAO.0000000000000884. PMID: 26485598. PMCID: PMC4692465.
Domínguez-Durán E, Moreno-de-Jesús C, Prieto-Sánchez-de-Puerta L, Mármol-Szombathy I, Sánchez-Gómez S. Identifying Training, Diagnostic and Therapeutic Needs From a Comparison in the Distribution of Vestibular Disorders in Primary Care and in a Neurotology Unit. Front Neurol. 2020;11:605613. https://doi.org/10.3389/fneur.2020.605613. PMID: 33329367. PMCID: PMC7714908.
Strobl R, Grözinger M, Zwergal A, Huppert D, Filippopulos F, Grill E. A Set of Eight Key Questions Helps to Classify Common Vestibular Disorders-Results From the DizzyReg Patient Registry. Front Neurol. 2021;12:670944. https://doi.org/10.3389/fneur.2021.670944. PMID: 33995265. PMCID: PMC8116658.
Kaski D, Tarnutzer AA, Agrawal Y, Carey J, Cha YH, Eggers SD, et al. The International Classification of Vestibular Disorders: Achievements, challenges, and future directions. J Vestib Res. 2025;35(3):105-112. https://doi.org/10.1177/09574271251313803. PMID: 39973600. PMCID: PMC12231871.
Soto-Varela A, Arán-González I, López-Escámez JA, Morera-Pérez C, Oliva-Domínguez M, Pérez-Fernández N, et al. Clasificación de los vértigos periféricos de la Comisión de Otoneurología de la Sociedad Española de Otorrinolaringología: concordancia diagnóstica y actualización (versión 2, año 2011). Acta Otorrinolaringol Esp. 2012;63(2):125-31. https://doi.org/10.1016/j.otorri.2011.10.004. PMID: 22169589.
Shepard NT, Jacobson GP. The caloric irrigation test. Handb Clin Neurol. 2016;137:119-31. https://doi.org/10.1016/B978-0-444-63437-5.00009-1. PMID: 27638067.
Barin K. Interpretation and usefulness of caloric testing. En: Jacobson G, Shepard NT, eds. Balance Function Assessment and Management. 2nd ed. San Diego: Plural Publishing; 2015. p. 319-46.
British Society of Audiology. Recommended procedure: The caloric test (2010), Vestibular assessment - eye movement recordings (2015), Positioning tests (2016) [Internet]. 2016 [consultado 22 mar 2026]. Disponible en: https://www.thebsa.org.uk/guidance-and-resources/current-guidance/?subject=balance
Pérez-Vázquez P, Franco-Gutiérrez V. La prueba calórica. Revista ORL. 2018;9(3):193-213. https://doi.org/10.14201/orl.17699.
Sanz-Fernández R, Martín-Sanz E. Exploración otoneurológica. Interpretación de las pruebas vestibulares. 1ª ed. Barcelona: Amplifón Ibérica; 2016. 336 p.
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. https://doi.org/10.3233/VES-2009-0343. PMID: 19893191.
López-Gentili LI, Kremenchutzky M, Salgado P. Análisis estadístico de 1.300 pacientes con mareo-vértigo. Causas más frecuentes. Rev Neurol. 2003;36(5):417-20. PMID: 12640592.
Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36(1):30-5. https://doi.org/10.1016/j.anl.2008.03.006. PMID: 18486378.
Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neurol. 2012;3:169. https://doi.org/10.3389/fneur.2012.00169. PMID: 23226141. PMCID: PMC3508265.
Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system. Nat Rev Neurol. 2017;13(6):352-62. https://doi.org/10.1038/nrneurol.2017.58. PMID: 28429801.
Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020;267(8):2252-9. https://doi.org/10.1007/s00415-020-09831-2. PMID: 32300888.
Xing Y, Si L, Zhang W, Wang Y, Li K, Yang X. Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study. J Neurol. 2024;271(5):2446-57. https://doi.org/10.1007/s00415-024-12495-x. PMID: 39042149. PMCID: PMC11377546.
Shen Y, Liu W, Qi X. Dizziness in a tertiary neurological department: A cross-sectional study. Brain Behav. 2023;13(2):e2864. https://doi.org/10.1002/brb3.2864. PMID: 36582121. PMCID: PMC9927854.
Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular Disorders. Dtsch Arztebl Int. 2020;117(17):300-10. https://doi.org/10.3238/arztebl.2020.0300. PMID: 32530417. PMCID: PMC7335649.
Bisdorff A. Vestibular symptoms and history taking. Handb Clin Neurol. 2016;137:83-90. https://doi.org/10.1016/B978-0-444-63437-5.00006-6. PMID: 27638064. PMCID: PMC5214453.
van de Berg R, Kingma H. History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach. J Clin Med. 2021;10(24):5726. https://doi.org/10.3390/jcm10245726. PMID: 34945023. PMCID: PMC8703413.
Pérez-Fernández N, Ramos-Macías A. Recent Advances in the Diagnosis and Treatment of Vestibular Disorders. J Clin Med. 2023;12(16):5281. https://doi.org/10.3390/jcm12165281. PMID: 37629323. PMCID: PMC10455078.
Yardley L, Medina SM, Jurado CS, Morales TP, Martinez RA, Villegas HE. Relationship between physical and psychosocial dysfunction in Mexican patients with vertigo: a cross-cultural validation of the vertigo symptom scale. J Psychosom Res. 1999;46(1):63-74. https://doi.org/10.1016/S0022-3999(98)00056-7. PMID: 10088983.
Mègnigbêto CA, Sauvage JP, Launois R. Validation clinique d'une échelle du vertige: EEV (European Evaluation of Vertigo). Rev Laryngol Otol Rhinol (Bord). 2001;122(2):95-102. PMID: 11715268.
Zhao JG, Piccirillo JF, Spitznagel EL Jr, Kallogjeri D, Goebel JA. Predictive capability of historical data for diagnosis of dizziness. Otol Neurotol. 2011;32(2):284-90. https://doi.org/10.1097/MAO.0b013e318204aad3. PMID: 21178804. PMCID: PMC3543606.
Paredis S, van Stiphout L, Remmen E, Strupp M, Gerards MC, Kingma H, et al. DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy. Front Neurol. 2021;12:771650. https://doi.org/10.3389/fneur.2021.771650. PMID: 34867759. PMCID: PMC8633101.
BENITO-OREJAS, J. I., BATUECAS-CALETRÍO, Ángel, FRANCO-GUTIÉRREZ, V., & ALONSO-VIELBA, J. (2026). Database of 1216 patients with dizzines-vertigo referred for oculographic evaluation and caloric test. Revista ORL, 17(2), e34466. https://doi.org/10.14201/orl.34466
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