FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the cross-sectional observational study on clinico- aetiological profile of patients with vertigo.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to is published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Vertigo is a subjective sensation of motion in which the individual or his/her surroundings seem to whirl dizzily. In the community, 1 in 5 of the adult population has suffered such symptoms with 30% of these suffering for more than 5 years. About 5-10% of patients seen in general OPD, and between 10-20 percent of the patients seen by otolaryngologists and neurologists are those with complaints pertaining to disequilibrium and vertigo. Owing to overlapping symptoms and terms such as dizziness, light headedness, giddiness and presyncope, a proper diagnosis is often challenging. Such diagnostic dilemma may well be seen in routine ENT or vertigo clinics. Though vertigo patients are also seen by neurologists and general physicians, the Otolaryngologist’s perspective is focused on peripheral vertigo. Certain conditions like benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuronitis are known common causes of peripheral vertigo in clinical practice. Lesser common ones being labyrinthitis and acoustic neuroma. The aim of this study is to revisit the various aetiological factors for vertigo in patients in contemporary Otolaryngology practice so as to further streamline the concepts and existing knowledge.
[004] In light of the foregoing, there is a need for the Cross-sectional observational study on clinico-aetiological profile of patients with vertigothat overcomes problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[005] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[006] The principal object of the present invention is to overcome the disadvantages of the prior art by providing the Cross-sectional observational study on clinico-aetiological profile of patients with vertigo.
[007] An object of the present invention is to provide the Cross-sectional observational study on clinico-aetiological profile of patients with vertigo for studying the clinical profile and revisit the various aetiological factors for vertigo in patients with actual sensation of rotatory motion seen in contemporary Otolaryngology practice.
[008] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[009] The present invention provides Cross-sectional observational study on clinico-aetiological profile of patients with vertigo.
[010] In one aspect of the present invention, the study comprises one-hundred and ten cases complaining of the sense of rotation of either head or their surroundings with at least a single episode in preceding one month are included;
[011] In another aspect of the present invention, omprehensive otological and vestibular evaluation is done;
[012] In another aspect of the present invention, each patient is subjected to thorough clinical vestibular and laboratory tests; and
[013] In another aspect of the present invention, subjects with known cervical spine disease, neurological disorders and cardiac ailments are excluded.
[014] In another aspect of the present invention, the mean age of patients in the study is 49.75 years with a male to female ratio of 1:1. Majority of the patients (90%) presented with acute onset of vertigo.
[015] In another aspect of the present invention, the total duration of symptoms most commonly observed ranged between one week to one month. Nearly, all patients had intermittent character of vertigo.
[016] In another aspect of the present invention, the duration of each episode in most of the patients ranged between 1 minute to 10 minutes. Maximum patients (90.9%) are observed with intensity of vertigo as mild and moderate type (Level II and III SVVSLCRE).
[017] In another aspect of the present invention, positional variation is observed in 64.5% of the patients.
[018] In another aspect of the present invention, the most common aetiological diagnosis deduced from the study is benign paroxysmal positional vertigo (30.4%) followed by orthostatic hypotension (17.9%) and Meniere’s disease (13.4%).
[019] In another aspect of the present invention, the most common aetiological factor of vertigo is found to be benign paroxysmal positional vertigo, which can be effectively treated by performing Epley’s maneuver.
[020] In another aspect of the present invention, orthostatic hypotension has been observed as an important cause liable to be missed by otologists.
[021] In another aspect of the present invention, the management of vertigo must be directed by a meticulous work up of aetiologies and should not be treated under a blanket regimen.

BRIEF DESCRIPTION OF DRAWINGS:
[022] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying figures. These figures are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[023] Table 1 Demographic characteristics (n=110).
[024] Table 2: Characteristics of vertigo symptom (n=110).
[025] Figure 1: Aetiological diagnosis of vertigo (n=110).
[026] Table 3: Association between positional variation and aetiological diagnosis in vertigo patients. (n=110).
DETAILED DESCRIPTION OF DRAWINGS:
[027] While the present invention is described herein by way of example using embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments of drawing or drawings described and are not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the drawings and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[028] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or are common general knowledge in the field relevant to the present invention.
[029] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[030] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[031] The present invention provides Cross-sectional observational study on clinico-aetiological profile of patients with vertigo.
[032] Inclusion criteria:
- All patients complaining of sense of rotation of self or surroundings with at least one episode in preceding one month.
- Patients who are more than 18 years of age.
[033] Exclusion criteria:
- Subjects with previous treatment history.
- Subjects with severe cervical spine disease, known cerebro-vascular disease, previous neurological disorders, known cardiac ailments, underlying mental illnesses.
[034] One-hundred and ten cases complaining of the sense of rotation of either self or their surroundings are recruited from the patients attending the Otorhinolaryngology department of the institute. A detailed history is obtained regarding the nature of symptoms, their onset, duration, frequency and other associated complaints. Severity of symptoms is graded as per Scale for Vestibular Vertigo Severity Level and Clinical Response Evaluation (SVVSLCRE). Sample size is calculated by estimation of proportion formula z pq/l2 where, z=95% confidence interval, p=50% (estimated prevalence 0.7-1.5%) [5]), q=1-p, l=20%. Comprehensive otological and vestibular evaluation is done in all cases. Bed side clinical tests are done which included Dix hallpike, Fistula test, Head Impulse test, Spontaneous Nystagmus testing, Romberg’s test and Gait testing. Laboratory tests included.
[035] Pure tone audiometry, Videonystagmography, Haemogram and random blood glucose levels. Though the focus of the authors is on peripheral vertigo, the cases who presented to the OPD after excluding the role of other specialities are hence included in the present study.
[036] Data is analysed using freely available software solutions (SPSS Version 22.00) and electronic spreadsheets (MS Excel) to store and manage the collected data. Descriptive analysis is done to determine means, frequencies and proportions of the various variables and findings are presented by means of graphs, tables and charts where appropriate. Chi-square test is used to assess any associations/relationships between outcomes i.e., aetiological diagnosis and variables such as presence or absence of postural variation.
[037] The mean age of patients in the study is 49.75 years with maximum patients in the age group of 41-50 years. The number of male and female patients is 55 each with male to female ratio of 1:1 [Table-1].
[038] Majority of the patients presented with acute onset of vertigo i.e., 99 (90%) patients. The total duration of symptoms most commonly observed ranged between one week to one month in 41 (37.3%) patients. Maximum patients 46 (41.8%) reported duration of each episode ranging between 1 minute to 10 minutes. Out of 110 patients, 109 patients reported with mild and moderate type of vertigo (Level II and III SVVSLCRE) i.e., it didn’t disrupt their day today activities significantly. Only 1 patient (0.9%) reported with vertigo severe enough to hamper the daily activities (Level IV SVVSLCRE) [Table-2].
[039] According to the study, most common aetiological diagnosis is BPPV which is observed in 34 (30%) patients followed by orthostatic hypotension which is observed in 20 patients [Figure-1].
[040] In present study, BPPV is significantly associated with positional variation in vertigo. Out of 34 (30.9%) patients of BPPV, 18 (18.2%) patients had positional variation. This is followed by the patients of orthostatic hypotension i.e., out of 20 (18.2%) patients, 15 (13.6%) patients had positional variation. Positional variation is observed in all 12 (10.9%) patients of benign recurrent vertigo. There is a significant statistical association between positional variation and the patients with vertigo [Table-3].
[041] In present study of 110 patients, 99 (90%) patients reported acute onset of vertigo and 11 (10%) patients reported insidious onset of vertigo. This is explained by the fact that benign paroxysmal positional vertigo, labyrinthitis and Meniere’s disease contributed to majority of the cases. Maximum patients i.e., 46 (41.8%) reported duration of each episode ranging between 1 minute to 10 minutes. This again can be attributed to the fact that in the present study, the patients of benign paroxysmal positional vertigo, orthostatic hypotension and labyrinthitis constituted the majority.
[042] A major proportion (64.5%) reported a positional variation in their symptoms which is explained by benign paroxysmal positional vertigo and orthostatic hypotension as observed in previous study. A study conducted by Jeon E et al., establishes a clear diagnostic significance of positional variation in benign paroxysmal positional vertigo and orthostatic hypotension. One hundred and seven patients (97.3%) reported intermittent character of vertigo and only three patients (2.7%) reported a continuous vertigo. The likely cause of continuous vertigo is mainly attributed to vestibular neuronitis, drug induced (anti-epileptic medication) vertigo and Meniere’s disease. Hypoglycaemia is excluded as having a causative role in present study. Three patients had deranged level of random blood glucose.
[043] The most common diagnosis observed in the study is benign paroxysmal positional vertigo (30.4%). This observation is similar to the study done by Neuhauser H and Lempert T who mentioned BPPV as the most frequent cause of dizziness. Similar results are reported by Burman D et al., who also observed it as the most frequent cause of vertigo. Patangay K et al., reported BPPV is the most frequent cause of vertigo amongst 205 cases. They diagnosed 43 cases of BPPV out of 205 cases i.e., 21%. In another study by Bansal M, BPPV is the most common cause of vertigo. Silva C et al., observed that head injury is associated with 10% of BPPV patients. In index study, head injury is present in 7 patients of BPPV, thus contributing 24.2% of the cases.
[044] Orthostatic hypotension is the second most common cause of vertigo in our study with 17.9% patients. Jeon E et al., observed orthostatic hypotension as a major cause of orthostatic dizziness with prevalence of 9.8%. In another study by Kim H et al., they found the patients had autonomic dysfunction (which is indicated by change in systolic blood pressure) as a cause of residual dizziness in BPPV patients. Maarsingh OR et al., had reported presyncope as the most common subtype of dizziness comprising 67% of the patients.
[045] In our study Meniere’s disease comprised 13.6% of the cases which is similar to Neuhauser H and Lempert T who observed 3 to 11% of the cases and Burman D et al., who diagnosed 10.5% patients as those having Meniere’s disease. However, Abrol R et al., observed it as a causative factor in only about 4% cases. In present study, 10.9% cases are diagnosed with benign recurrent vertigo. Similar observations are made by Neuhauser H and Lempert T who described a strong relation of vertigo symptoms to benign recurrent vertigo, comprising 10% of the 208 cases. In the present study, it is observed that 11 (10%) cases are diagnosed as labyrinthitis.
[046] Burman D et al., reported 7.4% cases whereas, Bansal M observed only 3.12% cases diagnosed with labyrinthitis. Whereas, Isaradisaikul S et al., described it as a lesser common diagnosis with labyrinthitis constituting just 0.7% of the cases evaluated by them. In present study, four (3.6%) patients are diagnosed with migrainous vertigo. It is in accordance with the observations made by Bansal M where 3.12% patients are found to have similar diagnosis. In the study by Neuhauser H and Lempert T they found a strong association between migraine and vertigo and it is the second most common cause of recurrent vertigo after BPPV. Five patients (3.6%) in the study are diagnosed with drug induced vertigo. Two patients had history of intake of antitubercular drug (injectable Streptomycin).
[047] Another two patients had history of anti-epileptic drug (Carbamazepine) intake. One patient is on polydrug regimen consisting of oral hypoglycaemics and multivitamins for diabetes mellitus, diabetic neuropathy and chronic renal failure. In a study, conducted by Sanchez-Sellero I et al., out of 18 patients studied with drug induced vestibulotoxicity, three patients are on anti-tubercular drugs (ethambutol, streptomycin and isoniazid). In a study conducted by Ferreira L et al., anticonvulsant medication intake is associated with 2.25 times increased risk of dizziness. In the present study, 3.6% patients are diagnosed with psychogenic vertigo. This is in spite of not having any previous underlying mental health condition. Bisdorff A et al., observed anxiety to be strongly related to symptoms of vertigo.
[048] Two (1.9%) patients in the study are diagnosed with Vestibular Neuronitis which constituted as the ninth cause in order of frequency. This is in contrast with the study by Neuhauser H and Lempert T who observed it as the second most common cause of vertigo. In another study by Burman D et al., it is observed that 6.4% patients are diagnosed with this condition. The strength of the present study is that positional variation observed in the cases is not solely attributed to BPPV out rightly. A careful evaluation identified orthostatic hypotension as a causative factor in a good number of cases. Further studies are suggested to establish the true prevalence of this condition.
[049] The most common aetiological factor of vertigo is found to be benign paroxysmal positional vertigo, which can be effectively treated by performing Epley’s maneuver and does not have other comorbid otological conditions. This is followed by orthostatic hypotension, which can be easily missed by otologists. Therefore, it should be kept as a possibility during work up of dizzy patients. Vertigo carries a large spectrum of aetiologies and hence should not be treated under a blanket regimen. The aetiological factors and diagnosis must be established in accordance with a meticulous clinical examination and investigations which should further guide the treatment strategy.
[050] The disclosure has been described withreference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[051] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) Across-sectional observational study on clinico-aetiological profile of patients with vertigo, the study comprisesone-hundred and ten cases complaining of the sense of rotation of either head or their surroundings with at least a single episode in preceding one month are included;
wherein omprehensive otological and vestibular evaluation is done;
wherein each patient is subjected to thorough clinical vestibular and laboratory tests; and
wherein subjects with known cervical spine disease, neurological disorders and cardiac ailments are excluded.
2) The cross-sectional observational study as claimed in claim 1, wherein the mean age of patients in the study is 49.75 years with a male to female ratio of 1:1. Majority of the patients (90%) presented with acute onset of vertigo.
3) The cross-sectional observational study as claimed in claim 1, wherein the total duration of symptoms most commonly observed ranged between one week to one month. Nearly, all patients had intermittent character of vertigo.
4) The cross-sectional observational study as claimed in claim 1, wherein the duration of each episode in most of the patients ranged between 1 minute to 10 minutes. Maximum patients (90.9%) are observed with intensity of vertigo as mild and moderate type (Level II and III SVVSLCRE).
5) The cross-sectional observational study as claimed in claim 1, wherein positional variation is observed in 64.5% of the patients.
6) The cross-sectional observational study as claimed in claim 1, wherein the most common aetiological diagnosis is deduced from the study is benign paroxysmal positional vertigo (30.4%) followed by orthostatic hypotension (17.9%) and Meniere’s disease (13.4%).
7) The cross-sectional observational study as claimed in claim 1, wherein the most common aetiological factor of vertigo is found to be benign paroxysmal positional vertigo, which can be effectively treated by performing Epley’s maneuver.
8) The cross-sectional observational study as claimed in claim 1, wherein orthostatic hypotension is observed as an important cause liable to be missed by otologists.
9) The cross-sectional observational study as claimed in claim 1, wherein the management of vertigo is directed by a meticulous work up of aetiologies and should not be treated under a blanket regimen.