Aetiology of Vertigo as Seen at the Federal Medical Center Lokoja , North Central Nigeria

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 2030% 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.

ertigo 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.' For example, cochlear symptoms like tinnitus and hearing loss may suggest that 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, comorbidities 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-V 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 .

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, period of illness 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 of 24.8 years.

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 by Adegbiji et al 9  this is low when compared to other studies done in time past [11][12][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][14][15]

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.

ETHICAL CONSIDERATION:
I confirm that I have read the Journal's position on ethical issues concerning this publication and I wish to declare that this manuscript is consistent with those guidelines.

CONFLICT OF INTEREST:
None to be declare.

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.

Table 2
Ogah SA.The prevalence of ear wax among the elderly in Lokoja, Nigeria.International