title: Two Common Second Causes of Dizziness in Patients With Ménière's Disease.
abstract: There are no epidemiological studies quantifying the prevalence of second causes of dizziness in Ménière's disease (MD). Therefore, we aimed to quantify which dizziness-inducing causes are prevalent alongside MD. Moreover, we analyzed which second cause of dizziness was more common in a specific age group and if age was a risk factor.
  
  
  
  Retrospective cohort study.
  
  
  
  Tertiary referral center.
  
  
  
  Data were retrospectively obtained from all MD patients who visited our clinic between January 2000 and December 2013. Workup included vestibular tests, pure tone audiometry, blood pressure monitoring, and the hyperventilation provocation test, the Nijmegen Questionnaire (NQ) and the Hospital Anxiety and Depression Scale (HADS). The final causes of dizziness were based on consensus between an ENT-surgeon and a neurologist who were consulted simultaneously.
  
  
  
  We found that 143 (30%) of 469 MD patients suffered from a second cause of dizziness. The two most common causes were psychological distress (PD) (70%) and benign paroxysmal positional vertigo (BPPV) (18%). The mean age for MD patients with PD was 58.7 ± 13.3 years compared with the mean age of 63.9 ± 14.3 years for MD patients without PD (mean difference = -5.2 years, 95% CI: -8.3 to -2.2, p = 0.001). MD patients younger than 60 of age had a 15% higher risk of suffering from psychological distress than those who were older than 60 (risk difference, 15%, 95% CI, 7.0-22%). Age could not be identified as a risk factor for BPPV in older MD patients.
  
  
  
  In 30% of the patients with MD a second cause of dizziness is present. PD most commonly coincides with MD, especially in younger patients. The second most common cause is BPPV.
authors.affiliation: *Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn†Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, The Netherlands.
authors.forename: Babette F
authors.initials: BF
authors.lastname: van Esch
authors.forename: Peter Paul G
authors.initials: PP
authors.lastname: van Benthem
authors.forename: Hester J
authors.initials: HJ
authors.lastname: van der Zaag-Loonen
authors.forename: Tjasse D
authors.initials: TD
authors.lastname: Bruintjes
mesh_terms: D000328:Adult; D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo / Q000150:complications*; D015331:Cohort Studies; D004244:Dizziness / Q000209:etiology*; D005260:Female; D006801:Humans; D008575:Meniere Disease / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D055815:Young Adult