Last modified: 2022-09-04
Abstract
Dizziness and vertigo are common chief complaints and have an extensive differential diagnosis that includes both benign and serious conditions. A growing body of evidence supports the use of vestibular rehabilitation (VR) in patients with dizziness, vertigo, as well as oscillopsia, tinnitus, motion sensitivity, imbalance, fear of falling, and secondary symptoms such as nausea and anxiety. Vestibular rehabilitation is an exercise-based programme that has been in existence for over several decades in many developed countries. However, in Ghana, vestibular-related symptoms are generally managed using a pharmaceutical approach, which tends to increase the risk of chronicity and reduce the quality of life. In September 2018, we set out to implement a VR programme in Ghana aimed at educating ear, nose and throat (ENT) specialists, neurologists, general practioners (GP) and physical therapists (PT). This is to create a more efficient referral system. Our implementation started with awareness programmes at two teaching hospitals, four regional hospitals, one medical clinic and two physiotherapy clinics. In addition to this, two physical therapists with no prior VR background were trained over the course of four six-hour sessions. Subsequently, 18 physical therapists were trained in a two-day workshop. As a result of our intervention, at least ten patients have been referred within the system. The age range was between 20 and 90 years, supporting that VR can be applied to all ages. Three patients were clinically diagnosed with benign paroxysmal positional vertigo (BPPV) and symptoms were fully resolved after canal-specific manoeuvers. Two patients presented with bilateral vestibular hypofunction which was successfully addressed. One patient had non-vestibular-related dizziness that was primarily cervicogenic in origin. The results from the last four patients are currently unavailable. From our experience, both medical practioners and patients were receptive to our intervention. Limitations we experienced include inadequate education about dizziness management, the over reliance on pharmaceutical intervention, inability to follow-up after in-services, and limited time available by the physical therapist community for continuing education outside of working hours. In conclusion, the educational interventions about vestibular disorders increased health professionals’ awareness of dizziness and vertigo and their knowledge about its management. More work is needed to improve the referral system between medical practioners and to further evaluate the effectiveness of VR in reducing dizziness and vertigo experienced by the Ghanaian population.