10 years of Vertigo Clinic at National Hospital Abuja, Nigeria: what have we learned?

Abstract

The clinician's major role in management of the dizzy patient involves determining what dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to details of history, otolaryngological workup including vestibular assessment, and often use of diagnostic and management algorithms. There is paucity of published reports of the management outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients presenting with features of peripheral vestibular diseases attending the National Hospital Abuja Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to April 2014) was carried out. Both institutions adopted the same diagnostic and management protocols. Data extracted from anonymized databases created for this study include age, sex, vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278 subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV (n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32), Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10), climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo recorded the highest DHI score (95 % CI 75 ± 4.3), followed by cholesteatoma/perilymph fistula (95 % CI 72 ± 6.1) and labyrinthitis (95 % CI 62 ± 1.9). Pure tone audiometry (95 % CI 67.3 ± 3.43), followed by thyroid function tests (95 % CI 66.7 ± 23.55) and ice-water caloric testing (95 % CI 59.7 ± 2.69) were investigations with the highest yields. 86.5 % of cases were treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to 75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and treatment yield in a resource-constrained setting like ours. Most cases can be managed using non-operative measures.

Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India

“…2,9 Peripheral vestibular diseases were reported to constitute a majority of the self-reported cases of vertigo during a 10-year period in Africa. 10 BPPV was the most common cause of vertigo reported in India. 11 Patients are affected differently depending on the underlying cause.…”

Vestibular migraine in low- and lower-middle-income countries: A scoping review

“…Most of the articles originated from India (n = 17, 65.4%) ( Anshul et al., 2020 ; Ashish et al., 2017 ; Bansal, 2016 ; Das et al., 2017 ; Dash et al., 2008 ; Haripriya et al., 2021 ; Lepcha et al., 2014 ; Mamindla et al., 2020 ; Prakash et al., 2008 , 2021 ; Prakash and Shah, 2009 ; Sen et al., 2016 ; Sunitha et al., 2019 ; Swain et al., 2018 , 2020 ; Syed et al., 2020 ; Udagatti and Dinesh Kumar, 2017 ), followed by Egypt (n = 3, 11.5%) ( El-Badry et al., 2017 ; ElSherif et al., 2020 ; Mostafa et al., 2014 ), Nigeria (n = 3, 11.5%) ( Adegbiji et al., 2014 ; Ogah, 2017 ; Olusesi and Abubakar, 2016 ), Iran (n = 1, 3.8%) ( Taghdiri et al., 2014 ), Tunisia (n = 1, 3.8%) ( Mouelhi et al., 2020 ), and Vietnam (n = 1, 3.8%) ( Ky et al., 2021 ) as represented by the heat map ( Fig. 2 ).…”

“…There was wide variability in the terminology used to describe VM among studies. Many variations of “migrainous vertigo,” such as “migraine-associated vertigo,” “migraine with vertigo,” and “migraine related vertigo,” were used (n = 10, 38.5%) ( Adegbiji et al., 2014 ; Das et al., 2017 ; Dash et al., 2008 ; Haripriya et al., 2021 ; Lepcha et al., 2014 ; Olusesi and Abubakar, 2016 ; Prakash et al., 2008 ; Prakash and Shah, 2009 ; Syed et al., 2020 ; Udagatti and Dinesh Kumar, 2017 ). “Vestibular migraine” was used in eight studies (n = 8, 30.8%) ( Ashish et al., 2017 ; El-Badry et al., 2017 ; ElSherif et al., 2020 ; Mamindla et al., 2020 ; Sunitha et al., 2019 ; Swain et al., 2018 , 2020 ; Taghdiri et al., 2014 ).…”

Vestibular function and curative effect of BPPV patients in different duration by application of electronystagmography and posturography.

“…Except for canalith repositioning maneuver, some other approach such as chemical or even operational method is also applied for BPPV therapy in clinic [8,22]. As reported by Olusesi and colleague, vestibular suppressant was 68.4% success, particle repositioning maneuver was 69% success, and chemical labyrinthectomy was 53.8% success [23]. Therefore, canalith repositioning maneuver is the most effective and common method currently.…”