What is the current status of care by neuro-otology specialists in Switzerland-A national survey

Andreas Zwergal; Georgios Mantokoudis; Dik Heg; Hassen Kerkeni; Suzie Diener; Roger Kalla; Athanasia Korda; Claudia Candreia; Antje Welge-Lüssen; Alexander A Tarnutzer

doi:10.3389/fneur.2023.1322330

What is the current status of care by neuro-otology specialists in Switzerland-A national survey

Front Neurol. 2023 Dec 7:14:1322330. doi: 10.3389/fneur.2023.1322330. eCollection 2023.

Authors

Andreas Zwergal^{1

2}, Georgios Mantokoudis³, Dik Heg⁴, Hassen Kerkeni⁵, Suzie Diener⁶, Roger Kalla⁵, Athanasia Korda³, Claudia Candreia⁷, Antje Welge-Lüssen⁸, Alexander A Tarnutzer^{9

10}

Affiliations

¹ German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany.
² Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Clinical Trials Unit Bern, University of Bern, Bern, Switzerland.
⁵ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Practice Neurology St. Gallen, St. Gallen, Switzerland.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.
⁸ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland.
⁹ Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
¹⁰ Faculty of Medicine, University of Zurich, Zurich, Switzerland.

Abstract

Background: Vertigo and dizziness are frequent presenting symptoms in the emergency department and in outpatient centers. While the majority of dizzy patients are evaluated by primary care physicians, specialists are often involved in the diagnostic workup. We aimed to gain more insights into the role of specialists in the care of dizzy patients.

Materials and methods: Board-certified neurologists and ear-nose-throat (ENT) physicians working in Switzerland were invited to participate in an online survey. Descriptive statistical analyses were performed, and prospectively defined hypotheses were assessed using correlation analyses.

Results: All 111 participating specialists (neurologists = 62; ENT specialists = 49) were familiar with testing for posterior canal benign paroxysmal positional vertigo (BPPV), and 66% regularly applied provocation maneuvers for suspected lateral canal BPPV. Reposition maneuvers for posterior (99%) and lateral (68%) canals were frequently performed. ENT physicians were familiar with lateral canal BPPV repositioning maneuvers significantly more often than neurologists (84 vs. 56%, p ≤ 0.012). Specialists strongly agreed that performing the head impulse test (86%) and looking for deficient eccentric gaze holding (82%) are important. Compared to neurologists, significantly fewer ENT physicians indicated ordering brain MRI in acutely dizzy patients (OR = 0.33 [0.16-0.067], p = 0.002) and physical therapy in patients with acute (50 vs. 20%, p = 0.005) or episodic/chronic dizziness (78 vs. 50%, p = 0.003).

Conclusion: We found substantial differences in the care of dizzy patients by neurologists and ENT physicians. This underlines the need for a standardized, guideline-oriented diagnostic workup and treatment across specialties. Dedicated training for performing lateral canal BPPV repositioning maneuvers should be prioritized for neurologists. Similarly, physical therapy should be considered more often by ENT physicians.

Keywords: bedside examination; diagnosis; dizziness; specialists; survey; vertigo.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. Funding for reimbursement for participation in the survey and for statistical analyses outsourced to the Inselspital were provided by Schwabe Pharma. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. GM was funded by the Swiss National Science Foundation #320030_173081.