Sudan Journal of Medical Sciences Volume 12, Issue no. 1, DOI 10.18502/sjms.v12i1.855 Production and Hosting by Knowledge E Research Article Aetiology of Vertigo as Seen at the Federal Medical Center Lokoja, North Central Nigeria Stephen Agbomhekhe Ogah Consultant Otolaryngologist, Head, and Neck Surgeon Department of Surgery, Federal Medical Centre Lokoja, Kogi State, Nigeria. P.O. Box 1256 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 How to cite this article: Stephen Agbomhekhe Ogah, (2017) “Aetiology of Vertigo as Seen at the Federal Medical Center Lokoja, North Central Nigeria,” Sudan Journal of Medical Sciences, vol. 12 (2017), issue no. 1, 19–24. DOI 10.18502/sjms.v12i1.855 Page 19 Corresponding Author: Stephen Agbomhekhe Ogah; email: stephenogah@yahoo.com Received: 15 December 2016 Accepted: 20 February 2017 Published: 28 May 2017 Production and Hosting by Knowledge E Stephen Agbomhekhe Ogah. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited. Editor-in-Chief: Prof. Mohammad A. M. Ibnouf http://www.knowledgee.com mailto:stephenogah@yahoo.com https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ Sudan Journal of Medical Sciences Production and Hosting by Knowledge E مستقبالت تكامل من مزيج من توازنهم على الحفاظ على قادرون البشر الخلفية: الجهاز قبل من والدهليزية البصرية والمدخالت الحسية الجاذبية الحسية، الوضعية العصبي المركزي. وبالتايل، يمكن أن تنشأ أعراض عدم التوازن كلما كان هناك خلل إما يف وهي ٪٢٠-٣٠ هو الدوار إنتشار المركزي. العصبي الجهاز أو الطرفية اإلستشعار أجهزة قضية صحية شائعة يف جميع أنحاء العالم. وسط شمال لوكوجا، االتحادي الطبي المركز يف الدوار وأسباب إنتشار لتحديد األهداف: نيجيريا. المواد والطرق: هى دراسة إستطالعية بأثر رجعي لثالث سنوات أجريت يف وحدة األنف واألذن والحنجرة من قسم الجراحة بالمركز الطبي اإلتحادي، لوكوجا. تم إسترجاع ملفات وتحليل ودراسة إستخراج تم بالمستشفى. الطبية السجالت من الدراسة قيد المرضى البيانات المتعلقة بعمرهم وجنسهم ومهنهم وعرضهم وطريقة عالجهم ونتائجه. دوار لديهم منهم ٦٥ كان مريضاً عشر وأربعة ومائتان آالف ثالثة مجموع من النتائج: بنسبة إنتشار ٢٫٠٪. وكان خمسة عشر ملفاً غير مكتملة المعلومات ولم تدرج يف الدراسة. أما ملفات المرضى الخمسين المتبقية التي تمت مراجعتها، فتتألف من ٣٢ ذكر (٦٤٪) و ١٨ أنثى (٣٦٪). وكانت نسبة الذكور إىل اإلناث ١٫٨: ١ ومتوسط عمر ٢٤٫٨ سنة. كان الدوار النوىب الموضعى الحميد المسبب األكثر شيوعاً ىف ٢٢ (٤٤٪) من الحاالت ثم مرض منير ٨ (١٦٪)، والصدمة ٧ (١٤٪) وإلتهاب العصب الدهليزي ٥ (١٠٪) على التوايل. 1. Introduction Vertigo is an illusion of rotatory movement of either the patient or his/her environment [1]. 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 aetiology [2]. For example, cochlear symptoms like tinnitus and hearing loss may suggest that DOI 10.18502/sjms.v12i1.855 Page 20 Sudan Journal of Medical Sciences Production and Hosting by Knowledge E the pathology is in the labyrinthine or VIII cranial nerve [3]. 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 diagnosis [3]. 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 days [4]. The prevalence of vertigo ranges from 20-30% in the USA [5], 4.9-21% in UK [6], 5% in Germany [7], 18.6% and 24.6% in two separate studies involving elderly patients in South Western Nigeria [8, 9]. 2. 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, presen- tation, period of illness treatment modality and outcome were extracted, studied and analyzed. 3. 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 (Table 2). 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 (Table 3). 4. 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 cetera [10]. 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 DOI 10.18502/sjms.v12i1.855 Page 21 Sudan Journal of Medical Sciences Production and Hosting by Knowledge E Age Group Male Female Total (%) 0-10 0(0.0%) 0(0.0%) 0(0.0%) 11-20 2(4.0%) 1(2.0%) 3(6.0%) 21-30 5(10.0%) 3(6.0%) 8(16.0%) 31-40 3(6.0%) 2(4.0%) 5(10.0%) 41-50 11(22.0%) 6(12.0%) 17(34.0%) 51-60 6(12.0%) 3(6.0%) 9(18.0%) 61-70 3(6.0%) 2(4.0%) 5(10.0%) 71-80 2(4.0%) 1(2.0%) 3(6.0%) Total 32(64.0%) 18(36.0%) 50(100%) T 1: Age and Gender distribution of patient with vertigo. Duration of vertigo Number of Patients % Seconds 25 50.0 Minutes 12 24.0 Hours 10 20.0 Days 3 6.0 Total 50 100.0 T 2: Duration of the vertigo. 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 past [11–13]. 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 researchers [13–15]. Aetiology of vertigo Number % BPPV 22 44.0 Meniere’s disease 8 16.0 Trauma 7 14.0 Vestibular Neuronitis 5 10.0 Unknown causes 4 8.0 Migraine 1 2.0 Diabetes 1 2.0 Ototoxicity 1 2.0 Cervical vertigo 1 2.0 Total 50 100.0 T 3: Aetiologies of the vertigo. DOI 10.18502/sjms.v12i1.855 Page 22 Sudan Journal of Medical Sciences Production and Hosting by Knowledge E 5. 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. 6. Ethical Consideration I confirm that I have read the Journal’s position on ethical issues concerning this publi- cation and I wish to declare that this manuscript is consistent with those guidelines. 7. Conflict of Interest None to be declare. 8. 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] J. P. Pattern, “Balance disorders and Vertigo,” in Scott-Browns Otolaryngology & Head-Neck Surgery, vol. 3, pp. 3932–3933, Hodder Arnold, 3, 7th edition, 2008. [2] M. Yin, K. Ishikawa, W. H. Wong, and Y. Shibata, “A clinical epidemiological study in 2169 patients with vertigo,” Auris Nasus Larynx, vol. 36, no. 1, pp. 30–35, 2009. [3] J.-M. Guilemany, P. Martínez, E. Prades, I. Sañudo, R. De España, and A. Cuchi, “Clinical and Epidemiological Study of Vertigo at an Outpatient Clinic,” Acta Oto- Laryngologica, vol. 124, no. 1, pp. 49–52, 2004. [4] N. Chawla and J. S. Olshaker, “Diagnosis and management of dizziness and vertigo,” Medical Clinics of North America, vol. 90, no. 2, pp. 291–304, 2006. [5] H. K. Neuhauser, “Epidemiology of vertigo,” Current Opinion in Neurology, vol. 20, no. 1, pp. 40–46, 2007. [6] B. Gopinath, C. M. McMahon, E. Rochtchina, and P. Mitchell, “Dizziness and vertigo in an older population: The Blue Mountains prospective cross-sectional study,” Clinical Otolaryngology, vol. 34, no. 6, pp. 552–556, 2009. [7] O. A. Sogebi, A. J. Ariba, T. O. Otulana, and B. S. Osalusi, “Vestibular disorders in elderly patients: Characteristics, Causes and consequences,” Pan African Medical Journal, vol. 19, 2014, article no. 146. DOI 10.18502/sjms.v12i1.855 Page 23 Sudan Journal of Medical Sciences Production and Hosting by Knowledge E [8] O. L. Akeem, “Prevalence, clinical and life-style correlate of dizziness among the community elderly from the ibadan study of ageing,” Ear Nose Throat J, vol. 93, pp. E37–E44, 2014. [9] W. A. Adegbiji, S. K. Aremu, B. S. Alabi, C. C. Nwawolo, and O. A. Olajuyin, “Vertigo presentation in developing country, Nigeria,” American Journal of Research Communication, vol. 2, no. 5, pp. 258–271, 2014. [10] S. A. Ogah, “The prevalence of ear wax among the elderly in Lokoja, Nigeria,” International Journal of Academic Research Part A, vol. 6, no. 6, pp. 49–50, 2014. [11] M. Karatas, “Central vertigo and dizziness: Epidemiology, differential diagnosis, and common causes,” Neurologist, vol. 14, no. 6, pp. 355–364, 2008. [12] S. 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DOI 10.18502/sjms.v12i1.855 Page 24 Introduction Materials and Methods Results Discussion Conclusions Ethical Consideration Conflict of Interest Funding and Support References