Vertigo

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Vertigo is a false sense of motion, spinning or feeling of imbalance. Sufferers often call it dizziness, imbalance, light-headedness or “chakkar aana”. Often the imbalance is associated with nausea, vomiting or unsteadiness on walking. It may worsen when you move your head. Vertigo should not be mixed up with acrophobia.

Vertigo and dizziness are common complaints presented by patients to doctors of all specialties, and they affect all age groups. It is a fact that 20-40% people are affected by dizziness at some point in time in their life; 15% people have dizziness; 5% have vertigo in any given year; 2.5% of all primary care visitors report dizziness, and 2-3% of emergency visits in the developed world is for vertigo.

But it must be noted that vertigo is not a disease. It is only a symptom of a disorder. Therefore, suppressing the symptom is not the solution. Proper diagnosis of what is causing vertigo/dizziness is possible only when the doctor makes a systematic evaluation.

Causes of Vertigo

• Meniere’s disease – It is a disorder of the inner ear, which is characterised by episodes of hearing loss and fullness in one ear, tinnitus and vertigo.
• Vestibular Neuritis – It is caused by a viral infection leading to inflammation of the vestibular nerve. The inflammation disturbs the balance function and causes dizziness.
• Otolithic Disorders – Damage to otolith organs (utricle and saccule) cause disequilibrium of the body and affects visual stability.
• Vestibular Migraine – It is vertigo associated with a migraine, either as a symptom of migraine or as a related but neurological disorder
• BPPV – It is a common cause of vertigo. It is seen more frequently in old aged population after an ear infection, head injury, surgery or after prolonged rest.
  Other causes include Labyrinthitis, Perilymph Fistula, Vestibular Paroxysmia, SSCD, MdDS, Acoustic Neuroma/ Vestibular Nchwannoma and Multiple Sclerosis to name a few.

Precautions & Treatments

• The doctor first examines the patient for facial weakness on one side of the face and including the forehead, eyelids, cheek and lips, in most cases. To detect and verify the extent of nerve damage, and to assess the likely pace of recovery, the doctor may advise a test called electroneuronography (ENoG). Magnetic resonance imaging (MRI) or computed tomography (CT) scan can be conducted to ensure any structural causes of pressure on the facial nerve.
• Bell’s palsy is not a permanent problem. Most patients regain facial control within a few weeks (or a few months, in some cases) even without treatment. However, if the attack is no more than 2-3 days old, the doctor will prescribe corticosteroids and/or antiviral medications for faster recovery.
• Bell’s palsy tends to affect the eyelid’s natural blinking ability which can cause irritation and dryness. If not taken care of adequately, it can lead to serious corneal damage. To keep the eye moist and shielded, the doctor will prescribe eye drops and eye patches until smooth eye closure begins again.
  An ENT surgeon will advise a surgery to a
• Bell’s palsy patient only in rare cases and only as a last resort when the facial paralysis is total and severe.

Symptoms

Patients suffering from persistent or intermittent dizzy spells usually describe their symptoms are

• Spinning, Swaying, Tilting
• Feeling unsteady or imbalanced
• Falling, Dizzy
• Difficulty in focusing on moving objects
• Nausea
• Change in hearing or ringing in the ears
• Difficulty in concentration

Precautions & Treatments

Vertigo is only a symptom. Diagnosis of the underlying cause using various diagnostic tests like VNG etc. is essential for correct treatment.

• Medications are prescribed as the first line of treatment to control the severity of dizziness and the discomfort that accompanies it, such as nausea, fatigue, anxiety, vomiting, difficulty in focusing, visual disturbance etc. Often patients with Vertigo are given medicines like Vertin, Stugeron, Meclizine Hydrochloride, Stemetil etc which suppress the symptoms. Taking these medications for the prolonged duration is dangerous. They should not be given for more than 5 days.
• Surgery is advised for rare cases of vestibular disorders as inner ear surgeries are quite complex.
• Vestibular Rehabilitation exercises and Canalith Repositioning manoeuvres are prescribed for appropriate Vestibular problems. Vestibular rehabilitation exercises are very useful in gaining balance, normalising visual disturbance and reducing dizziness in a short span of time. Canalith Repositioning maneuvers are done for patients suffering from BPPV. The type and side of BPPV are diagnosed, and then the recommended repositioning maneuver like Epley manoeuvre, Semont manoeuvre, Barbeque maneuver etc. is performed.

Some tips to avoid vertigo / dizziness include

• Avoid sleeping on the side of problem ear
• Elevate your head with a pillow while sleeping
• Try to sleep on time
• Reduce salt and caffeine in your diet
• Avoid food with preservatives
• Avoid alcohol and carbonated drinks
• Do not skip meals/fast
• Reduce screen time: cell phone, TV and Computer