Evaluation of patients who applyied to the otolaryngology outpatient clinic with the complaint of dizziness and their management in family medicine

AIM: In this study, we aimed to evaluate the demographic characteristics, diagnosis and treatment processes of patients who applied to Muğla Training and Research Hospital Otorhinolaryngology outpatient clinic due to dizziness and also to gather information about the management of vertigo patients by family physicians at primary health care services. MATERIAL AND METHOD: Patients aged 18 years and older who applied to the Muğla Training and Research Hospital Ear Nose and Throat outpatient clinic with the complaint of dizziness between 7 March 2022 and 7 June 2022 were evaluated. The patients included in the study were informed about the study and their written consent was obtained. A questionnaire form containing 22 questions prepared by the researchers by examining the literature was filled with the face-to-face interview technique with the patients. In addition to sociodemographic characteristics, this questionnaire includes questions about the characteristics of vertigo and questions about the complaints of vertigo and the patients' applications due to vertigo to primary health care services. After filling out the questionnaire, physical examinations of the patients were performed by ENT physicians. Otoscopy and positional tests were performed on all patients. Audiometry exam and vHIT (video Head Impulse Test) were performed on some patients who were deemed suitable. Vestibular rehabilitation recommendation and benefit status were recorded by physicians. Also they recorded the physical examination findings, the results of the spesific tests, the diagnosis and treatment of the patient. Data analysis was done with SPSS 21.0 and studied at 95% confidence level. In our analyses, frequency and percentage values were calculated for categorical variables. The relationship between categorical variables was analyzed with the Chi-square test. RESULTS: 166 patients with dizziness participated in the study. 68.1% of the patients were female and 31.9% were male. The mean age is 51.9 ± 15 years. The lowest age is 18 and the highest is 84. 73.5% of the patients are married, 26.5% are unmarried. 30.7% are employed, 69.3% unemployed. 76.5% of the patients did not apply to family medicine due to dizziness. The reason why they did not prefer family medicine was because 82.8% wanted to be examined by a specialist. The diagnosis was 51.2% peripheral vestibular disease, 25.3% central vestibular disease, 16.3% systemic disease, 7.2% uncertain. Of the patients diagnosed with peripheral vestibular disease, 45.3% were diagnosed with BPPV, 38.4% with vestibular hypofunction, 9.3% with vestibular neuritis, and 7% with Meniere's Disease. Positional tests results of the patients were found to be normal in 74.7% and pathological in 25.3%. Audiometry exam was performed in 88 out of 166 patients, and 59.1% of them were found to be normal and 40.9 pathological. According to the vestibular tests results of 59 patients, the rate of those who were normal was 54.2%. There was a significant relationship between the age and education level of those who applied to family medicine. In the same group, 63.6% were between the ages of 41-60, 72.7% were primary school-middle school-high school(at least one of them) graduates. A significant relationship was found between the frequency of applying to family medicine and age, marital status, educational status, employment status and presence of chronic disease. Those who are over 40 years old, married, primary-secondary-high school(at least one of them) graduates, unemployed and those with chronic diseases are more likely to apply to family medicine. The patients who have never applied to family medicine before are mostly unmarried, college-university graduates, employed and have no chronic disease. CONCLUSIONS: In our study, we found that the sociodemographic characteristics of patients with vertigo and the distribution of clinically underlying pathologies were mostly consistent with the data in the literature. According to the data we obtained, most of the dizziness patients do not prefer primary health care services because of these complaints. The majority of those who do not prefer state that they want to be examined by specialist. It is known that some additional complaints and additional diseases accompanying clinical vertigo have an important place in the differential diagnosis of peripheral, systemic and central vestibular diseases. We thought that the differential diagnosis of patients with dizziness can also be made in primary health care institutions by anamnesis, physical examination, otoscopy and positional tests, and they can be referred for further examination and treatment when deemed necessary.