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A study of the prevalence of vestibulocochlear disorders in 4,825 patients showed that these disorders occurred during middle age and mostly affected women. The doctor's answer to the question "Does my illness occur frequently?" is based on the doctor's professional experience and, in many cases, reflects the reality of only his or her background, which may not be applicable to all cases. It is well-known fact that the incidence of labyrinthine disorders, especially in older people, is high. Conraux and Gentine [2] believe that 7% of neurootological pathologies are attributable to Meniere's disease, whereas Toupet [3] estimates that this etiology accounts for 5% of such pathological processes.
Because references in the literature are so few and as some of the reports are contradictory, we undertook to evaluate the prevalence of different pathological processes in patients suffering from vestibulocochlear disorders. At the Otorhinolaryngological Department of the Faculty of Medical Sciences, UNICAMP, and our private clinic, 4,825 patients who complained of vestibulocochlear disorders and were treated during the 3-year period from March 1994 to February 1997. Table 2 shows that vestibulocochlear disorders occur more frequently in women, the female-male ratio being 2: 1.
An analysis of Table 3 shows that the most frequent etiologies of labyrinthine disorders are vascular. Patients, whose examination results were normal, suffer equilibrium disorders due to emotional and psychological disturbances.
The incidence of cervical syndrome is rising owing to the prevalence of professions such as computer programming and typing. Changes in sugar metabolism (diabetes and reactive hyperinsulinemia) are responsible for more than 80% of metabolic labyrinthine disorders.
Allergy to food in the case of labyrinthine hydrops is approximately 20%, and respiratory allergies are rare.
Most of the incomplete diagnoses were cases referred by other doctors, but some were our patients. A great majority of the cases of vestibulocochlear disorders caused by trauma could be attributed to loud noise (industries, dance halls, etc.) and traffic accidents. In most cases of vestibular neuritis, it was not possible to correlate equilibrium disorders with previous respiratory infections.
Most authors have cited paroxysmal positional vertigo as the most frequent vestibular pathological process but, in our study, we found it to be rare.
Although the preceding sample is smaller, it can be seen that vestibular migraine is prevalent, which is in accordance with data provided by Toupet [10].
Table 6 reveals that cases of emotional disorders are high also among patients aged 20-30 years.
In the 40- to 50-year age group (Table 8), the incidence of cervical syndrome is highest, whereas the incidence of normal patients and cases of vestibular migraine is far less. Table 9 shows that vascular labyrinthitis is more frequent in patients aged 50-60 years, cervical syndrome being the next most prevalent disorder. Table 10 shows that the incidence of circulatory disorders among 60- to 70-year-olds is very high: 40% vertigo, followed in incidence by the cervical syndrome.
The expected high incidence of vascular labyrinthitis among patients older than 70 was confirmed in our study (Table 11). As expected, vascular labyrinthitis was revealed as a pathological process of the aged and, regardless of gender, occurs most frequently in the patient's sixth decade (Table 12).
Table 13 demonstrates that the incidence of emotional disorders is highest among patients in their thirties.
The highest incidence of cervical syndrome (Table 14) in patients of either gender is during the fourth decade, when years of bad posture begin taking their toll. In Table 15, it can be seen that vestibular migraines affect men more intensely between the ages of 10 and 20 years, which could be due to emotional instability during puberty, whereas women are more affected by vestibular migraines during their thirties. The incidence of metabolic labyrinthitis (Table 16) is highest in the 30- to 50-year age group. The highest incidence of Meniere's disease (labyrinthine hydrops) in either gender is during the fourth decade of life, as shown in Table 17.


Table 18 shows that the highest incidence of vestibular neuritis is during a person's thirties. As shown by Table 19, as well as by Baloh and Honrubia [14], paroxysmal positional vertigo is not benign and could last for years. Traumatic labyrinthitis affects men more intensely during their thirties than in any other period (Table 20), traffic accidents or even job accidents being the most likely etiology. Table 21 demonstrates that the highest incidence of sudden deafness, with or without vertigo, is during a person's thirties, confirming the results obtained by Nakashima et al.
This work was presented at the Twenty-Fifth Neuorootological and Equilibriometric Society Congress, March 19-22, 1998, Bad Kissingen, Germany.
Mr David A Bowdler is an ENT Consultant at University Hospital Lewisham, and is an Honorary Senior Lecturer to GKT. He trained in the UK, as well as in Paris, Antwerp and Nijmegen with some of the most eminent Otologists in Europe.
Mr Bowdler has developed his otological interest across the breadth of the sub-speciality with an extensive practice in the fields of hearing loss, chronic ear disease, vertigo, tinnitus and otosclerosis. He teaches, publishes and presents extensively, especially about diseases of the middle ear, both nationally and internationally. Ear disease, dizziness, tinnitus and deafness, Otosclerosis, Otitismedia (glue ear), middle ear & mastoid disease and surgery, implantable hearing aids (Esteem). The most frequent pathologies are vascular labyrinthitis, emotional disturbance, and the cervical syndrome.
Paroxysmal positional vertigo, which most researchers believe is the most common pathological finding, was identified by Mizukoshi et al. A 6-month respite was allowed between the last evaluation and the compilation of the research results so that the diagnoses could be confirmed, as there had been a probable case of sudden deafness that recurred 4 months later, accompanied by a crisis of vertigo that was eventually identified as Meniere's disease and another case of vestibular neuritis that, months later, after a relapse, proved to be multiple sclerosis.
It reveals that few of the patients knew that equilibrium disorders are treated by otoneurologists and that many of the patients sought the advice of a cardiologist rather than a neurologist.
However, not computed were cases of vestibular migraine, which, despite being main, can be considered peripheral as it is extremely benign.
In addition, youngsters who lie back in front of the television and maintain the neck in a bent position for many hours invite this syndrome. However, it was noted that in 93 cases (73%), the left side was compromised, and only 1 case was affected bilaterally.
These data coincide with the studies done by Hughes and Proctor [5], who diagnosed 187 cases (24%) of positional vertigo in 781 patients who suffered from vertigo but, on review, concluded that only 36 cases (4.6%) were true canaliculithiasis, whereas the remaining cases were vascular disorders and even labyrinthine hydrops. In women, this disorder is surprisingly highly prevalent, whereas in men it occurs with a frequency similar to that of vestibular neuritis. However, the importance of emotional disorders can be seen in the group of patients aged 10-20 years who are affected by vestibular migraine.
Table 7 shows that the largest number of cases of emotional disorders are in the 30- to 40-year age group and that, in this group, such disorders are more frequent than are cases of vestibular migraine. This reflects the patients' lack of confidence felt at this age, the difficulty in securing a job or in rising professionally.
The cause very often (75% of cases) is an alteration in the metabolism of sugar (diabetes and reactive hyperinsulinemia). Its highest incidence in women is during their forties, which is close to the figure (50 years) found by Baloh and Honrubia.
In contrast, women suffer traumatic labyrinthitis more often after the age of 40, generally as a result of physical aggression suffered in the home.
Women are more affected than men by vestibulocochlear disorders, the female-male ratio being 2: 1. The 40- to 50-year age group is most affected, followed by those between the ages of 30 and 40 years, proving that these disorders do not affect only the aged. The most frequent pathological processes, in descending order, are vascular labyrinthitis, psychological and emotional disturbance, cervical syndrame, vestibular migraine, metabolic labyrinthitis, and Meniere's disease.


Each disease affects a particular age group, which could change according to the patient's gender.
Colledge N, Wilson J, Macintyre C, MacLennan W: The prevalence and characteristics of dizziness in an elderly community. Gracia-Naya M, Marta E, Uson M, Carod J: Estudio epidemiologico descriptivo de una consulta externa de neurologia.
Stein M, Asmundson G, Ireland D, Walker J: Panic disorder in patients attending a clinic for vestibular disorders. This list of celebrities who died from liver cancer includes information like the victim's hometown and other biographical information when available.
The study also demonstrated that each disease has a preferential age group, which varies according to the gender.
The very small number of children referred by pediatricians demonstrates that there is lack of information regarding neurootological disorders in this area. In children, the classic pulsating headache is not present in most cases of vestibular migraine; rather, the most frequent symptoms are motion sickness and classic vertigo.
Diagnosis in chronic renal cases is very difficult as most of these patients also have important ototoxic symptoms.
Also noted in this group is a high incidence of Meniere's disease, which, according to most authors, is thought to occur rarely before the age of 20 years.
The incidence of cervical syndrome also was high, but the incidence of presbyvestibular disorders was outstanding.
The audiometric tests performed on young people indicated virotic lesions, whereas in the aged, vascular lesions were more common. Unfortunately many famous people's lives have been cut short because of liver cancer, including actors, musicians and athletes.This list contains people like Alec Guinness and Robin Gibb.
Vestibulocochlear disorders often incapacitate an individual during his or her most productive phase and, as a result, impose serious social problems. These data differ greatly from most reports by other authors, who indicate that this is a pathological process generally found in the aged [15].
However, in the group in which the incidence was highest, it was not possible in most cases to obtain a differential diagnosis. This list answers the questions, "Which celebrities have died from liver cancer?" and "Which famous people died due to liver cancer?"These notable liver cancer deaths include modern and past famous men and women, from politicians to religious leaders to writers. In 11% of the cases, an infection of the upper respiratory tract was confirmed a few days before vertigo was felt. Everyone on this list has has liver cancer as a cause of death somewhere in their public records, even if it was just one contributing factor for their death.
Grad and Baloh [7] admitted that vascular alterations take place very frequently in vestibular disorders. Manhattan, Paul Bowles: The Complete Outsider, Me and My Brother, Pull My Daisy, + more see more on Allen Ginsberg> 3 Alec Guinness Photo Credit Sir Alec Guinness, CH CBE was an English actor.
After an early career on the stage he was featured in several of the Ealing Comedies, including The Ladykillers and Kind Hearts and Coronets in which he played eight different characters.
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Causes of unilateral tinnitus referral
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