ISSN 1612-3352

Editors in Chief

Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

Production Managers

Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.


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Dizziness study test comparizon

Abstract

Introduction
Dizziness is met in more then 20% of Global population. It appears to be the third reason of patient admittance to the doctor in USA . According to Cochrane reports 22.9% of German population met dizziness during last year, the life quality of such persons is crucially decreased . In the literature the dizziness definitions are not clear-cut: “every discomfort sensation in the head might be regarded as dizziness” . Poor definitions results in subjectivism in diagnostics, situation is reflected in Cochrane reviews. The latter studies suggest that the evidence base for dizziness evaluation and management is weak. Meta-analyses and systematic reviews are particularly important for clinicians because these study designs minimize bias and summarize evidence in a manner useful to clinicians. Most studies of medical tests pertaining to dizziness evaluate vestibular tests. Only few guidelines give consensus support of the clinical utility of vestibular tests. The guidelines, however, do not summarize important measures of diagnostic accuracy (e.g., sensitivity, specificity, and likelihood ratios) – the information which is the most useful when making medical decisions. When the sensitivity and specificity of posturography was assessed by a meta-analysis design, both of these operating characteristics were only about 50% for identifying vestibular disorders – indicating that the test results do not influence the probability of the outcome. Imaging studies are increasingly used in dizziness evaluations, but no meta-analysis was found that measures the operating characteristics of these tests in dizziness presentations. No guidance is proposed to clinicians about who needs an imaging study. In fact, none of the guidelines were even intended to be a clinical practice guideline for dizziness. Other than BPPV and Meniere’s disease, meta-analyses and systematic reviews were only found on alternative interventions. The main purpose of the guideline on Meniere’s disease was to establish design and reporting criteria for research studies. The statement on acoustic neuroma stems from a National Institutes of Health Consensus Development Conference – which aim to present useful consensus information to health professionals, but not are not intended to be clinical practice guidelines. The guideline on ischemic stroke only briefly addresses dizziness. Research should address questions such as, “Which dizziness patients are likely to benefit from having a brain image, vestibular test, audiogram, or blood analyzis?” – since these tests are expensive, inconvenient and often bothersome to patients, and are generally of very low yield. Evidence for interventions – other than re-positioning for BPPV – is either insufficient or absent entirely. Thus, more empirical studies, systematic reviews and meta-analyses on relevant dizziness topics are needed so that evidence is established in a way that will inform clinicians and also research agendas. Guideline statements can then be developed to translate evidence into actual recommendations for clinical care. With these goals as priorities, future work could make an important contribution to the efforts to optimize patient care and healthcare utilization for one of the most common symptom presentations in all of medicine [cited after 19]. That is why we have desided to start with comparative analyzis of the methods used to study vestibular system condition in dizzy patient from the evidence-based medicine position.

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