Diagnosis and Management of Benign Paroxysmal Positional Vertigo in a West African Country

Adegbiji, Waheed Atilade and Aremu, Shuaib Kayode and Adewoye, Kayode Rasaq and Ibrahim, Tayo (2021) Diagnosis and Management of Benign Paroxysmal Positional Vertigo in a West African Country. JOURNAL OF CRITICAL REVIEWS, 8 (1). pp. 1-8. ISSN 2394-5125

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Abstract

Objectives: Management of benign paroxysmal positional vertigo is inadequate in many developing countries. Also, there is a paucity of literature on benign paroxysmal positional vertigo in developing countries including West African countries. This study aimed at determining the pathological distribution, clinical presentation, comorbid illnesses, patients limitations, prehospital and Specialist treatment of benign paroxysmal positional vertigo in our center. It will also form the basis for further study on benign paroxysmal positional vertigo. Methods: This was a prospective hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo. Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike manoeuvre and supine roll test was performed on all patients. All the patients were treated appropriately by Epley manoeuvre and Semont liberation manoeuvre. All the data obtained were collated and analysed by using SPSS version 18.0. Results: The mean age of the patients studied was 48.7. Males accounted for 46.1% with male to female ratio of 1:1.2. There was unilateral benign paroxysmal positional vertigo in 99.4% and right benign paroxysmal positional vertigo in 64.3%. 66.2% was posterior semicircular canal followed by 24.7% lateral semicircular canal. Majority 83.8% had more than 4 episodes before the presentation. Commonest clinical experience among our patients was vertigo, nystagmus, and loss of balance in 85.1%, 81.8%, and 80.5% respectively. Chronic cases (greater than 3 months) of benign paroxysmal positional vertigo occurred in 92.9%. 97.2% of the patients were reviewed ear, nose, and throat outpatient clinic. Associated comorbid illnesses were a visual disorder, hypertension, arthritis and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6% respectively. Patients major sources of referral was a general practitioner in 57.8%. The Commonest affected quality of life among patients was anxiety in 31.8%. It limits the daily activities of patients in 31.8% movement restrictions, 29.9% avoid turning on the bed, 24.7% indoor and 1.9% avoid driving a car. Majority 72.7% of the patients had one or more form of prehospital treatment. These were 46.1% pharmacy consultation, 30.5% over the counter drugs, 44.2% spiritual intervention, 23.4% herbal medication and 5.2% dietary approach. Majority 65.6% of the patients were on one or more form of medication(s) of which labyrinthine sedative was 63.0%. Conservative treatment was offered in 79.2%. Only 59.1% had canalith repositioning manoeuvres at presentation with two or more sessions in 50.6%. Comorbid illnesses were responsible for referral in 9.1% for experts review and management. Conclusion: Benign paroxysmal positional vertigo is a common otologic disorder with significant comorbid illnesses which limits patients daily activities and affect their quality of life. The illness was associated with late presentation and poorly treated by an unskilled hand, thus there is a need for public enlargement on vertigo and treatment.

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