A Study on Aetiopathology and Clinical Evaluation of Vertigo

Introduction: Dizziness and the perception or hallucination of movement, typically rotation, of oneself, the environment, or both are characteristics of vertigo, a common complaint in therapeutic practice. Postural instability, cold sweats, nausea, and vomiting are examples of secondary symptoms. 1 However, the term "dizziness" is frequently used to characterize a number of feelings (vertigo, presyncope and disequilibrium).1,2 Vertigo frequently presents in both primary care settings and emergency rooms. It has been described as a sign of vestibular dysfunction. Vertiginous sensations must be distinguished from other types of dizziness, such as lightheadedness, which is most frequently linked to presyncope. Vertigo is frequently associated with variety of etiologies. It might be challenging for a doctor to describe the type of dizziness a patient is experiencing and to make a management decision. Though there are various studies on Vertigo, there are fewer studies studying the underlying cause, especially in the given study population  area. Thus this study is designed  to elucidate the frequency of causes underlying the development of vertigo in the patients seeking advice and care at an outpatient healthcare facility. Objective: The study is to describe the pathophysiology of vertigo , to determine the cause of vertigo using history,bedside examination and investigations . Materials and Methodology: A prospective study with 100 patients clinically presenting with vertigo attending ENT OPD  are included .All the patients were subjected to a thorough history, clinical examination and various bed side tests like Head thrust test, Dynamic visual acuity, Head shaking test, Dix Hallpike test, Fukuda’s test and Calorie test and investigations like CT / MRI brain, X-Ray neck, Blood sugar, Lipid profile, Carotid vertebral Doppler as needed.The data collected has been analysed to determine the common cause of vertigo,it’s pathophysiology,bedside assessment and requisite investigations in the establishment of diagnosis. Results: Among the study population, the mean age was 42.83 ± 14.47 years. Descriptive analysis with associated symptoms; 50.00% of them had Deafness, 30.00% of them had Tinnitus, 9.00% of them had Vomiting, 5.00% had aural fullness. Study population with Central Cause;  5.00% of them were Migrainous vertigo, 3.00% of them were vertebrobasilar insufficiency, 2.00% of them were post circulation stroke and 1.00% with cervical vertigo ; with peripheral cause,  47.00% of them had BPPV, 12.00% of them had Ménière’s disease and 21% had vestibular neuritis . With systemic causes ; 5.00% of them had diabetes mellitus, 3.00% of them had hypothyroidism, ,  5.00% of them had hypertension. The descriptive analysis of the signs were , 47.00% of them had Nystagmus; 19.00% of them had Dix Hallpike Test positive ; 19.00% of them had Head Thrust test positive ; 34.00% of them had Dynamic Visual Acuity positive ; 31.00% of them had Head Shake Test positive ; 32.00% of them had Calorie Test positive . Conclusion: Vestibular vertigo is common in the general population, affecting 80% in our study population who came with vertigo as a chief complaint . The frequency and health care impact of vestibular symptoms at the population level have been underestimated. One should keep in mind all the central cause and co morbidities which accounts for 20% of the OPD patients in our study . The most frequent causes of cardiogenic and otogenic dizziness, respectively, were uncontrolled hypertension and BPPV. The study came to the conclusion that peripheral vertigo may be recognized and distinguished from other causes with ease if thoroughly investigated. At a vertigo clinic, people with dizziness can be efficiently managed.20