Vestibular disorders among adults in a tertiary hospital in Lagos, Nigeria

Abstract

Dizziness is not an uncommon complaint in the Otolaryngological clinics among other symptoms. To a large number of practitioners, the treatment of dizziness remains the same irrespective of the etiology, i.e., anti-vertiginous drugs. The objective of this study was to document the evaluation, causes and treatment of vestibular disorders among our patients. The design includes descriptive prospective study conducted in the Oto-rhino-laryngology and Orthopedic Clinics of Lagos University Teaching Hospital, Lagos and Nigerian Army Audiological Centre, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Adult patients referred to the audiology clinic for dizziness had detailed history obtained by using structured questionnaire. General physical and neuro-otological examinations were done. Clinical diagnoses were made on standardized criteria. The patients had hearing evaluation, videonystagmography (VNG) evaluation using infrared videonystagmography system. X-ray of the cervical spine and computerized tomogram scan of internal auditory meatus and brain when indicated were done. A total of 102 patients were seen with age range between 21 and 90 years. Thirty patients (29.4%) recorded average duration of episode of vertiginous attacks in seconds, 69 (67.6%) recorded within minutes to hours and 3 (2.9%) with no definite pattern. Clinical signs on neuro-otological examination were elicited on 39 (38.2%) of the patients while on VNG the vestibular subtest mainly caloric test was abnormal unilaterally and bilaterally in 47 (46.1%) while with the oculomotor subtests, smooth pursuit tests were abnormal in 5 (6.9%), saccade tests were abnormal in 8 (7.8%) and OPK were abnormal in 9 (8.8%). Peripheral vestibular disorders are common of which benign paroxysmal positional vertigo (BPPV) was seen in 29 (28.4%), Meniere's disease in 22 (21.6%), recurrent vestibulopathy in 20 (19.6%), cervical vertigo in 18 (17.6%), psychogenic vertigo in 2 (2%), vestibular schwannoma, barotraumas and drug-induced vertigo in 1 (1%), respectively, central vestibular disorders of vascular origin 2 (2%), vertebrobasilar insufficiency in 1 (1%), post-traumatic vertigo in 3 (3%) and unknown in 2 (2%). In conclusion, peripheral vestibular disorders are common of which BPPV is the most prevalent. Pre-referral anti-vertiginous medication is common among general practitioners. The practising ORL/Head neck surgeon and orthopedic surgeons must be conversant with the tools of diagnosis, differential diagnosis and treatment.

Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo

“…In the study by Somefun et al, 16 i Completeness of outcome data: = below 10% missing data; s = 10% or more missing data; ? = unclear, no information provided.…”

The peripheral vestibular disorders encountered in the routine out-patient practical work

“…Эти заболевания составили 94,1% всех случаев периферических вестибулярных расстройств, выявленных у обследованных пациентов. Наши данные подтверждают результаты аналогичных исследований, проведенных в зарубежных клиниках и выявивших значительное преобладание периферических вестибулярных заболеваний среди причин головокружения [13,14]. Вопреки распространенному мнению, цереброваскулярная патология, так часто диагностируемая у пациентов с жалобами на головокружение, встречалась значительно реже и существенно уступала по распространенности периферическим вестибулярным заболеваниям.…”

Clinical Characteristics of Cervicogenic-Related Dizziness and Vertigo

“…2 Cervical vertigo can be a rare cause of vertigo 3 or it can be among its main causes. 4 In the elderly, Colledge et al suggested that cervical spondylosis is the second most-frequent cause of dizziness, which would be more representative of those who complain of dizziness to their general practitioner. 5 Advocates of vertigo of cervical origin state that cervical vertigo is the most common cause of vertigo; however, there is no diagnostic method to establish whether a patient's vertigo is caused by an underlying neck condition.…”