Study of positional vertigo in elderly patients of Ranchi population

 

 

Abstract               Background: Balance disorders, un-steadiness, dizziness and vertigo in elderly are the significant health problems. Vertigo remains quite challenging to treat and mange in the elderly. Method: 68 elderly patients aged between 60 to 75, were studied and diagnosed was confirmed by DIX Hall pike maneuver and head roll test. Along with age related disease were also noted with blood examination and X-ray USG study. Results: Associate diseases were 29(42.6%) had DM with HTN, 10(14.7%) had UTI, 13(19.1%) had respiratory diseases 11(16.1%) had arthritis,5(7.3%) had fractures. The clinical manifestation were 5(7.3%) had nausea, 3(4.4%) had vomiting 21(30%) had rotational vertigo,17(25%) had imbalance, 12(17.6%) had fear of falls 10(14.7%) had Nystagmus Conclusion: This empirical study of positional vertigo, clinical manifestations and associated age related complications quite helpful to ENT surgeon and physician to treat efficiently to avoid morbidity and fatal consequence.

Key Words: Dix Hall pike, Nystagmus, Un-stability, Balance –disorder

 

INTRODUCTION

Prevalence of positional vertigo is believed to be a focal disorder of the in nearer with manifestation which effects the well being and functional capacity of the suffering¹. It occurs more frequently in women than men (2:1)² and its prevalence increases with age³. Positional vertigo arises from displacement of otoconia fragments into the semicircular, however a critical mass is needed to evoke the clinical symptoms⁴. As mere presence of fragments within the semicircular canal is not always sufficient to induce a chance in vestibular nerve activity. Because of the Anatomy of the inner ear, the posterior semicircular canal is more commonly affected, but lateral and superior canal can be also involved. In majority of cases Dix-hall pike and head roll test can effectively lead to diagnose. The natural history of positional vertigo is one of the self-limiting disease in which symptoms resolve as octoconia fragment dissolve into endolymph. The rate of dissolution of the fragments is dependent on calcium concentration within the endolymph such that low concentration lead to faster resolution. But concentration varies in elderly patients leads to severity in the vertigo and aggravate the clinical symptoms. Hence attempt was made to evaluate the positional vertigo in elderly patients

 

MATERIAL AND METHODS

68 elderly Patients aged between 60 to 75 years having positional vertigo regularly visiting Gandhi Nagar Hospital CCL Ranchi- 0834048 were studied,

Inclusive criteria

The elderly patients having complaints of non-specific dizziness and instability and a few had rotatory vertigo, balance disorder

Method

Patients typically describe the rotation of environment during on abrupt change of position, as when rising from supine position, getting on object from above and other circumstances of hyper extension of neck. Diagnosis was confirmed by Dix-Hall Dike maneuver ⁵. ( The test was performed by bringing down the patients rapidly from a sitting position to a position with head hanging 20-40 below horizontal over the edge of the bed with the test ear under most ) Moreover oscillopsia, nausea, vomiting, imbalance, fear of falling, falls and syncope were also noted. Routine blood examination was related out to know the common associated problems like DM-II, UTI, serum calcium was rule out in suspected Osteoporotic patients. Otoscopy and otolarangeal examinations also done to know any associated problems. The duration study was from March 2019 to August 2019

Inclusive criteria

Patients had Minier’s diseases, migrainous, vertigo, vestibular neuronitis, malignant and immune compromised were excluded from the study

Statistically Analysis

(a) The associated diseases of elderly patients were classified with percentage.(b) Clinical manifestations of position vertigo in elderly patients were also classified with percentage. The ratio of male and female were 1:2

 

OBSERVATION AND RESULTS

Table-1 In associated disease of elderly patients with position vertigo- 29(42.6%) had, Diabetic mellitus with Hypertension. 10(14.7%) had urinary tract infections 13(19%) had respiratory diseases, 11(16.1%) had arthritis, 5(7.3%) had fractures. Table-2 Clinical manifestation of positional vertigo in elderly patients 5(7.3%) had nausea, 3(4.4%) had vomiting, 21(30%) had rotation vertigo 17(25%) had imbalance 12(17.6%) had fear of falls.10 (14.7%) had Nystagmus.

Table 1: The Associate diseases of elderly patients with positional vertigo (Total No of patients -68)

 

Table 2: Clinical manifestations of positional vertigo in elderly patients (Total No of patents 68)