Vertigo Management – Mapping prevalence and treatment. Understanding once a day preparation usage and place in therapy.

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Total Respondents = 20

Response to question

Responses

% of Responses

Start with OD

12

60

Only Maintenance with OD

8

40

Table 52: Responses for preferred use of once a day formulation

Interpretation:
·         60% of the Cardiologists prefer to use O.D formulation as a start up dose, while the rest (40%) preferred to use it as a maintenance dose only.

15.   Is the usage of OD preparation indication specific?

Total Respondents = 20

Response to question

Responses

% of Responses

Yes

1

5

No

19

95

Table 53: Responses for use of once a day formulation indication specifically

Interpretation:
·         Majority (95%) of the Cardiologists do not use O.D formulation particularly specific to any indication.
·         Only 5% of Cardiologists use it specific to any particular condition.

16.  If yes, which is the indication and any specific reasons?

5% of the Cardiologists use O.D formulation in Acute cases of vertigo. They also prefer to use it in patients with severe symptoms.

17.  Do you also use two anti-vertigo molecules like morning/evening dose?

Total Respondents = 20

Response to question

Responses

% of Responses

Yes

2

10

No

18

90

Table 54: Responses for usage of two Anti-vertigo molecules

Interpretation:
·         90% of the Cardiologists do not use two Anti-Vertigo molecules together.
·         Only 10% of the Cardiologists use two Anti-vertigo molecules together as a morning-evening dose

If Yes, your usual approach

Sometimes Betahistine is prescribed with Dimenhydrinate or Cinnarizine.

18.  Do you think, combination of Betahistine with Dimenhydrinate is required? If yes, for which indication and condition is it useful?

Total Respondents = 20

Response

Number of Responses

% of response

Yes

9

45

No

1

5

Maybe

1

5

Not tried

9

45

Table 55: Responses for usage of combination of Betahistine with Dimenhydrinate

Interpretation:
·         45% of the Cardiologists have not tried this combination, but 45% said it to be a potent and viable combination.
·         They were further aided by 5% of doctors who felt it maybe a fruitful combination.
·         5% of Cardiologists feel that this would not serve to be a good combination.

E.N.T PHYSICIANS & SURGEONS

E.N.T( SAMPLE SIZE = 35)
·         The incidence of, 15-25% patients was found to be a majority amongst 40% E.N.T doctors, who have administered anti-vertigo medications.
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst E.N.T Doctors.
·         51.43% of the E.N.T Doctors felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         51.43% E.N.T Doctors reported that 40-50 years was the prevalent category of the patients.
·         51.53% of E.N.T Doctors observed Vertigo patients with Secondary to pre-existing ailment
·         Diabetes Mellitus is the most common secondary to pre-existing ailment amongst 47.36% E.N.T doctors, followed by Hypertension & Cardiac problems in 28.95% and Spondylosis (10.52%) amongst the E.N.T Doctors.
·         BPPV is the most common cause of Vertigo, followed by Vestibular Neuronitis and Labyrinthitis amongst the sampled E.N.T Doctors.
·         Pharmacological and Manoeuvres is the most preferred line of treatment amongst 49.28% E.N.T Doctors for effective Vertigo management.
·         Betahistine) is the most preferred drug of choice for treating vertigo amongst 61.11% E.N.T Doctors followed by 14.81% who use Cinnarizine.
·         48.57% of the E.N.T Doctors prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·         1-2 weeks is the most preferred duration of therapy with Betahistine amongst 62.86% E.N.T Doctors
·         88.57% of the E.N.T Doctors were found to titrate the dosage in Vertigo treatment.
·         With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage was increased.
·         All of the E.N.T doctors (100%) were found to be aware of Betahistine once a day preparation.
·         57.14% of the E.N.T Doctors did not use Betahistine O.D formulation, they reportedly used the conventional doses.
·         Amongst all E.N.T Doctors those who use Betahistine once a day preparation, 73.33% mostly prescribe 24mg C.R, while 26.67% use 48mg C.R formulation.
·         The duration for which 24mg C.R is prescribed the most is 1 week by 53.33% E.N.T Doctors, followed by 2 weeks amongst 20% E.N.T Doctors.
·         Majority of the E.N.T doctors (62.86%) prefer to use O.D formulation as a start up dose, while the rest (37.14%) preferred to use it as a maintenance dose only.
·         Majority (85.71%) of the E.N.T doctors do not use O.D formulation particularly specific to any indication.
·         14.29% of the E.N.T doctors use O.D formulation in Acute cases of vertigo. They also prefer to use it in patients with severe symptoms.
·         85.71% of the E.N.T Doctors do not use two Anti-Vertigo molecules together.
·         40% of the E.N.T Doctors have not tried this combination, but 54.29% said it to be a potent and viable combination.

They were further aided by 2.86% of doctors who felt it maybe a fruitful combination.

1.      In your practice what is the incidence of patients who need anti-vertigo medication?

Total Respondents = 35

Category

Responses

Percentage of responses

5-10%

1

2.86

10-15%

8

22.86

15-25%

14

40

More than 25%

12

34.28

Table 56: Responses for incidence of patients requiring Anti-Vertigo Medication per week

Interpretation:
·             The incidence of, 15-25% patients was found to be a majority amongst 40% E.N.T doctors, who have administered anti-vertigo medications.
·             34.28% of the E.N.T doctors reported of more than 25% patients requiring anti-vertigo medication
·             The incidence of 10-15% & 5-10% patients were also reported amongst 22.86% & 2.86% E.N.T doctors respectively.

2.      May I know the approximate bifurcation of patients gender wise (in %)?

Table 57: Responses for gender bifurcation of patients requiring Anti-Vertigo Medication per week

Total Respondents = 35

% of Patients

Approx Ratio

Responses

% of Responses

Male

40

18

51.43

Female

60

 

Male

50

4

11.43

Female

50

       

Male

30

13

37.14

Female

70

Interpretation:
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst E.N.T Doctors.
·         51.43% of the E.N.T Doctors felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         30:70 (Male:Female) ratio was observed amongst 37.14% E.N.T Doctors.
·         11.43% E.N.T Doctors observed an equal ratio of 50:50 (Male:Female) in their practice.

3.      Is it more predominant in any particular age group?

Total Respondents = 35

Age of Patients

Responses

% of Responses

Below 20 years

0

0

20-40 years

1

2.86

40-50 years

18

51.43

Above 50 years

16

45.71

Table 58: Responses for prevalent age group of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         51.43% E.N.T Doctors reported that 40-50 years was the prevalent category of the patients.
·         2.86% E.N.T Doctors found 20-40 years category to be more prevalent in their practice.
·         Patients above 50 years age was reported with 45.71% E.N.T Doctors, while there were no patients reported below 20 years.

4.      Of these patients reported, do you get most patients as primary vertigo/dizziness patients or it is secondary to some pre-existing ailment?

Total Respondents = 35

Type

Responses

% of Responses

Primary

17

48.57

Secondary

18

51.43

Table 59: Responses for category of patient having secondary to pre-existing ailment

Interpretation:
·          51.53% of E.N.T Doctors observed Vertigo patients with Secondary to pre-existing ailment
·         It was revealed through the study that 48.57% of the E.N.T Doctors, observed patients with Primary Vertigo.

5.      If it is secondary to pre-existing ailment, what is the most common pre-existing disease/disorder you see?

Total Respondents = 18 multiple responses (out of 35 E.N.T doctors)

Disorder

Responses

% of Responses

Diabetes Mellitus

18

47.36

Hypertension & Cardiac problems

11

28.95

Thyroid

2

5.26

Spondylosis

4

10.52

Otitis Media

3

7.89

Table 60: Responses for patents having most common secondary to pre-existing ailment

Interpretation:
·         Diabetes Mellitus is the most common secondary to pre-existing ailment amongst 47.36% E.N.T doctors, followed by Hypertension & Cardiac problems in 28.95% and Spondylosis (10.52%) amongst the E.N.T Doctors.
·         7.89% reported Otits Media & 5.26% reported Thyroid as the most common secondary to pre-existing ailment respectively.

6.      What are the most common causes of Vertigo that you see in your practice?

Total Respondents =35

Cause

Frequency of Ranks

Rank 1

Rank 2

Rank 3

Rank 4

Rank 5

Rank 6

 

BPPV

33

1

 

 

 

 

 

Vestibular Neuronitis

2

9

12

5

1

 

 

Labyrinthitis

1

12

7

5

 

 

 

Meniere’s Disease

 

12

9

2

2

 

 

Spondylosis

 

1

2

2

2

 

 

Migraine

 

 

 

4

1

 

Table 61: Table depicting the most common cause of Vertigo as ranked

Interpretation:
·         BPPV is the most common cause of Vertigo, followed by Vestibular Neuronitis and Labyrinthitis amongst the sampled E.N.T Doctors.
·          Meniere’s Disease and Spondylosis were the other causes reported by the E.N.T Doctors (in decreasing order of occurrence).
·         Migraine is the least significant cause of Vertigo.

7.      What is the usual line of treatment?

Fig 57: Bar chart showing the preference in line of treatment for Vertigo management

Total Respondents = 35 (multiple responses)

Line of Treatment

Responses

% of Responses

Lifestyle modification

1

1.45

Pharmacological

33

47.82

Manoeuvres only

1

1.45

Pharmacological and Manoeuvres

34

49.28

Table 62: Responses for usual line of treatment in Vertigo management

Interpretation:
·         Pharmacological and Manoeuvres is the most preferred line of treatment amongst 49.28% E.N.T Doctors for effective Vertigo management.
·         47.82% E.N.T Doctors also resort to Pharmacological therapy for treating Vertigo.
·         1.45% E.N.T doctors reported Lifestyle modification and Manoeuvres only respectively for vertigo management.

8.      In pharmacological treatment what is your drug of choice?

Fig 58: Bar chart showing the preference in line of treatment for Vertigo management

Total Respondents = 35 (multiple responses)

Molecule

Responses

% of Responses

Betahistine

33

61.11

Cinnarizine

8

14.81

Dimenhydrinate

4

7.41

Combination

7

12.96

Any other

2

3.71

Table 63: Responses for molecule management in Vertigo management pharmacologically

Interpretation:
·         Betahistine) is the most preferred drug of choice for treating vertigo amongst 61.11% E.N.T Doctors followed by 14.81% who use Cinnarizine.
·         7.41% E.N.T Doctors prescribed Dimenhydrinate and 12.96% E.N.T Doctors prefer to use a combination of drugs (Betahistine with Dimenhydrinate / Cinnarizine) to treating Vertigo.
·         3.71% use other drugs (Dimenhydrinate only)

9.      May I know your usual treatment approach?

Total Respondents = 35

 

8 mg

16mg

24mg

24mg C.R

48 mg C.R

OD

--

--

--

1

--

BID

--

4

5

--

--

TID

17

5

1

--

--

Table 64: Chart showing the type of Betahistine dose prescribed for treating Vertigo

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