HOME ABOUT US INSTRUCTIONS SUBMISSION REGISTER ADVERTISE CONTACT

PAST ISSUESCURRENT ISSUE

Volume 12, Number 1 (March 2017) , 15-18

Original Article

Aetiology of Vertigo as Seen at the Federal Medical Center Lokoja,

North Central Nigeria

Stephen Agbomhekhe Ogah1*

 

 

 

ABSTRACT

Background: Human beings are able to maintain their balance from a combination of proprioceptive, graviceptive, visual and the vestibular inputs integrated by the central nervous system. Hence, symptoms of imbalance can arise whenever there is a defect either in these peripheral sensors or the modulating central nervous system. The prevalence of vertigo is 20-30% and it is a major health issue all over the world.

Objectives: To determine the prevalence and causes of vertigo in Federal Medical Center Lokoja, North Central Nigeria.

Materials and Methods: This is a 3-year retrospective hospital based study undertaken in the ENT Unit of the Department of Surgery Federal Medical Centre, Lokoja. From the hospital Medical Records, patients' files were retrieved. Data about their age, sex, occupation, presentation, treatment modality and outcome were extracted, studied and analyzed.

Results: Three thousand two hundred and fourteen patients were seen and 65 of them had vertigo with a prevalence of 2.0%. Fifteen files had incomplete information and were not include in the study. The remaining 50 patients' files that were reviewed, consisted of 32 males (64%) and 18 females (36%). Male to female ratio was 1.8:1 and a mean age of 24.8 years. Bengin Paroxysmal Positional Vertigo (BPPV) 22(44%) was the commonest aetiology found followed by Meniere's disease 8(16%), trauma 7(14%) and Vestibular Neuronitis 5(10%) respectively.

Keywords: Aetiology, vertigo, BPPV, Meniere's disease.


 

 

 

 

 

 

Vertigo is an illusion of rotatory movement of either the patient or his/her environment1. The causes can be summarized using the word 'VERTIGO' itself as a mnemonic, where 'V' stands for vestibular diseases like vestibular neuronitis, 'E' stands for endocrine diseases like hypergycaemia in diabetes. 'R' stands for receiving drugs, such as ototoxic drugs like the aminoglycosides, antimalarias like quinine and chloroquinine, anticancers like cisplatin etc. 'T' stands for trauma of any kind affecting the vital areas. 'I' stands for infections like labyrinthinitis, vestibular neuronitis, petrositis and otitis media. 'G' stands for growth (neoplasm) such as acoustic neuromas, glomus tumours and 'O' stands for ocular diseases, other diseases like demyelinating diseases like multiple sclerosis and the non-specific cochleovestibulopathies. At clinic presentation, other symptoms may be necessary in making the diagnosis of the aetiology2. For example, cochlear symptoms like tinnitus and hearing loss may suggest that the pathology is in the labyrinthine or VIII cranial nerve3.

Symptoms like diplopia, dysarthria and facial weakness may suggest brain stem causes. Drug history, duration, co-morbidities and previous surgeries are also very important in making the diagnosis3.In Benign Paroxysmal Positional Vertigo, there is usually a latent phase and the vertigo only last for a few seconds (5-10secs), in the migraine type, it usually can last from some minutes to a few hours. Whereas in Meniere's disease, it may last for hours and in vestibular neuronitis it usually lasts for days4. The prevalence of vertigo ranges from 20-30% in the USA5, 4.9-21% in UK6, 5% in Germany7, 18.6% and 24.6% in two separate studies involving elderly patients in South Western Nigeria8,9.

 

 

MATERIALS AND METHODS:

This is a 3-year retrospective hospital based study undertaken in the ENT Unit of the Department of Surgery Federal Medical Centre, Lokoja. From the hospital Medical Records, patients' files were retrieved. Data about their age, sex, occupation, presentation, period of illness treatment modality and outcome were extracted, studied and analyzed.

 

 

RESULTS:

Three thousand two hundred and fourteen patients were seen and 65 of them had vertigo with a prevalence of 2.0%. Fifteen files had incomplete information and were not include in the study. The remaining 50 patients' files that were reviewed, consisted of 32 males (64%) and 18 females (36%). Male to female ratio was 1.8:1 and a mean of 24.8 years.
Twenty five patients had their vertigo occurring within seconds consisting 50% of the study population, 12(24%) were in minutes, 10(20%) occurring in hours and 3(6%) in days (table2). Majority of the patients (44%) suffered from BPPV followed by Meniere's disease (16%), trauma (14%), Vestibular neuronitis (10%) and (8%) of unknown etiology. Migraine, Ototoxicity, Diabetes and vertebrobasillar insufficiency were the least aetiologies found in this study (table3).

Table1. Age and Gender distribution of patient with vertigo

 

Table 2: Duration of the vertigo

 

Table 3: Aetiologies of the vertigo

 

 

DISCUSSION:

Vertigo is a symptom associated with so many ear diseases but usually subsides when the causative disease is given the proper treatment. One should not be surprised to find it in association with diseases as simple as impacted wax, otitis media, otitis externa et cetera10.

Male preponderance was notice in this study which is probably due to the increase trauma cases in our hospital located along Okene/Abuja high way. Vertigo was noticed to be more common in males in their fifth decade of life although a study by Adegbiji et al 9 who found it more in females with a bimodal age distribution. However, the lower modal age is similar to that found in this study.

Vertigo prevalence found in this study is 2.0% and this is low when compared to other studies done in time past11-13. This low prevalence may be due to lack of awareness by the communities where the hospital is located or patients perhaps deciding to use alternative traditional medication due to the level of growing poverty amongst our people.

The duration of most vertigo lasted for a few seconds and only few of them lasted for some days which further support the diagnosis of BPPV. These findings are in agreement with what has been reported by other researchers13-15 .

 

 

CONCLUSIONS:

Benign Paroxysmal Positional Vertigo was found to be the commonest aetiology of vertigo in this study and that early referral of patients to the ENT specialist is advised for cost effective treatment.

 

 

ETHICAL CONSIDERATION:

I confirm that I have  read  the  Journal’s  position  on ethical issues concerning this publication and I wish to declare that this  manuscript is consistent with those  guidelines.

 

 

CONFLICT OF INTEREST:

None to be declare. 

 

 

FUNDING AND SUPPORT:

This work was done as part of scientific programs of the Department of Surgery Federal Medical Center, Lokoja, Kogi state, Nigeria and that there was no financial support to be acknowledge.

 

 

REFERENCES:

1.       Pattern JP. Balance disorders and Vertigo: In Scott-Brown’s Otolaryngology & Head-Neck Surgery; 7th edition; Hodder  Arnold 2008; 3: 3932-3933.

2.       Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo AurisNasus Larynx.2009; 36(1): 30–35

3.       Guilemany JM, Martinez P, Prades E, et al. Clinical and epidemiological study of vertigo at an outpatient clinic. Acta Otolaryngol.2004;124(1):49-52.

4.       Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo.Med Clin North Am. 2006;90:291–304.

5.       H.K. Neuhauser. Epidemiology of vertigo.CurrOpinNeurol, 2007; 20 (1):404–406

6.       Gopinath B, McMahon CM, et al. Dizziness and vertigo in an older population: the Blue Mountains prospective cross-sectional study. ClinOtolaryngol. 2009; 34(6): 552-556.

7.       Sogebi OA, Ariba AJ, Otulana TO and Osalusi BS. Vestibular disorders in elderly patients: characteristics, causes and consequences. The Pan African Medical Journal.2014; 19:146.

8.       Lasisi AO and Gureje O. PREVALENCE, CLINICAL AND LIFE-STYLE CORRELATE OF DIZZINESS AMONG THE COMMUNITY ELDERLY FROM THE IBADAN STUDY OF AGEING. Ear Nose Throat J. 2014; 93:37–44

9.       Adegbiji WA, Aremu SK,Alabi BS, Nwawolo CC and Olajuyin OA. VERTIGO PRESENTATION IN DEVELOPING COUNTRY, NIGERIA.American Journal of Research Communication. 2014; 2(5): 258-271

10.    Ogah SA. The prevalence of ear wax among the elderly in Lokoja, Nigeria. International Journal of Academic Research Part A; 2014; 6(6):49-50.

11.    Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008; 14(6):355-64

12.    Isaradisaikul S, Navacharoen N, Hanprasertpong C, Kangsanarak J and PanyathongR. Causes and time-course of vertigo in an ear, nose, and throat clinic Eur Arch Otorhinolaryngol, 2010; 267(12):1837–1841.

13.    Shami I and Al Sanosi A. Causes of Vertigo in
Saudi Patients Seen at Tertiary Teaching Hospital. Journal of Taibah University Medical Science.2011; 6(1):26–32

14.    Adedeji TO, Tobih JE and Olaosun AO. Peripheral Vestibular Disorders and Its Management in a Nigerian Teaching Hospital.World Journal of Medicine and Medical Science. 2014; 2 (2): 2330 – 1341

15.    Nwaorgu OGB, Onakoya PA, Usman MA. Cervical vertigo and cervical spondylosis-A need for Adequate Evaluation.Nig Journal of Medicine. 2003; 12(3):140-144

 

 

 

1. Consultant Otolaryngologist, Head and Neck Surgeon.

*Department of Surgery, Federal Medical Centre Lokoja, Kogi State, Nigeria. P.O.Box 1256.

Email: stephenogah@yahoo.com

Mobile: +2348075224222

 

Copyright ©Sudan JMS.
All Rights Reserved