A Comparative Study of Metabolic Disorders in Vertigo

Abstract

BACKGROUND Vertigo is a common medical condition, affecting around 1.8% of young adults to more than 30% in the elderly. Metabolic disorders commonly related to labyrinthine dysfunctions are glucose metabolism changes (diabetes, reactive hypoglycaemia and hyperinsulinaemia), thyroid hormones and lipid metabolism disorders. The objective of this study is to compare the prevalence and association of metabolic disorders in vertigo cases to control under study. MATERIALS AND METHODS A case controlled study was done on patients presenting in ENT OPD, VIMSAR, Burla, with complaints of vertigo. 110 patients were chosen for the study between September 2015 and August 2017 and compared to age and gender matched controls (110). All patients and controls had the following blood investigations done: Fasting Blood Sugar (FBS), Oral Glucose Tolerance Test at 2 hrs. (OGTT2), thyroid profile (Free T3, Free T4, TSH) and Lipid Profile (Triglyceride (TG) and Low-Density Lipoprotein (LDL)). The metabolic disorders found were also compared to the ones found in the general population. The results were tabulated on excel sheets and statistical comparison and analysis was done with SPSS Version 16.0. Mann-Whitney U Test and chi-square test was applied for comparison. Statistical significance was set at p < 0.05. RESULTS The no. of vertigo patients with Type-2 diabetes mellitus were higher (1) in patients than controls. (2) Cases had more prevalence of thyroid disorders (3) than controls. (4) The incidence of abnormal lipid profile was higher in cases (35 cases with impaired TG, 27 cases with impaired LDL) than controls (17 each with impaired TG and LDL). The difference was significant in majority of parameters (FBS-p < 0.015; OGTT2-p < 0.316; T3-p < 0.000; T4-p < 0.002; TSH-p < 0.000; TG-p < 0.003; LDL-p < 0.814). The difference of diabetics and impaired glucose status in between cases of vertigo and controls are not statistically significant (p=0.770, ꭓ=0.086, chi-square test). The difference is highly significant in between cases and controls of thyroid disorder (p=0.002, ꭓ= 14.66) and lipid disorder (p= 0.000, ꭓ= 12.53, chi-square test). CONCLUSION Metabolic impairments in vertigo are substantial and hence cannot be ignored in management. FBS, TSH, T3, T4, TG and LDL values of cases were impaired more than controls and the difference was statistically significant for FBS, TSH, T3, T4, TSH and TG. Cases in our study had significantly higher prevalence of thyroid and lipid disorders than controls. This study could be applied in management of patients with chronic vertigo by dietary therapy or hormone replacement.

Association between diabetes and vestibular dysfunction: an integrative review

“…Bepari et al 20 , when evaluating the hemograms of a group of diabetic patients, identified high values of thyroid-stimulating hormone (T3, T4 and TG), besides the increase in low-density lipids (LDL). The increase in serum cholesterol is one of the risk factors for the development of atherosclerosis, which also has a role in the vestibulocochlear vessels, especially in individuals over 40 years old.…”

“…The increase in serum cholesterol is one of the risk factors for the development of atherosclerosis, which also has a role in the vestibulocochlear vessels, especially in individuals over 40 years old. Hence, the importance of multidisciplinary clinical follow-up is highlighted, including hormonal and dietary therapy 20 .…”

“…The influence of the MS on the vestibular system as a factor associated with irreversible cochleovestibular deterioration was investigated in three studies 12,13,20 . The term MS refers to a set of risk factors that increase 15 Utricular dysfunction Neuropathy and retinopathy Albernaz, 2016 16 Vestibular and cochlear dysfunctions Hypoglycemia and hyperglycemia D'Silva et al, 2017 17 BPPV SAH and peripheral neuropathy Jáuregui-Renaud et al, 2017 18 Dizziness and vertigo peripheral neuropathy, retinopathy, and SAH Endolymphatic hydrops was prevalent in 45% of the individuals with MS associated with dyslipidemia.…”