Most of us remember the reeling sensation felt when we got out of a merry-go-round. This sensation of disturbance of balance is dizziness or vertigo. There is a feeling of the environment going around or oneself spinning around. About 80 per cent of times the origin is associated with the balance system in the ears called the vestibular system .Vertigo is a symptom that causes lot of anxiety and discomfort and drains the confidence of the sufferer.
Dizziness can also be a symptom of diseases of the heart, brain, metabolic and hormonal imbalance. Hence the key to management of dizziness is finding the cause of the symptom. This requires clinical examination and appropriate investigations.
Dizziness is associated with several other symptoms like light headedness, true fainting, tiredness, weakness, feeling off balance, head ache, facial numbness and drooping, pain in the eyes , blind spots and twinkling in eyes, dryness in the mouth, nausea, vomiting. Chest pain with shortness of breath and tingling of extremities and weakness of limbs should not to be ignored.
Vertigo can be associated with a variety of symptoms and the causes are multiple. The mainstay of treatment is identification of the cause at the earliest .
Life threatening diseases presenting with the symptom should be ruled out at the earliest.
True vertigo is usually caused by an assault to the vestibular system and its central connections. The sufferer complains of a spinning sensation with associated nausea and vomiting in severe cases. The sensation can last for a few seconds in some conditions to few hours to days in some.
Benign positional vertigo lasts for a few seconds and is triggered by certain head positions .
Vestibular neuronitis lasts for days and it is followed by a bout of viral infection.. Labyrinthitis follows ear infection and is associated with hearing loss.
Meniere’s disease vertigo can last for a day and it recurs. It is associated with ringing in the affected ear and progressive hearing loss. Use of certain vestubulotoxic drugs can cause imbalance which is reversible in certain cases.
There are no standard protocol or algorithm to assess Vertigo. For each patient specific treatment approach is to be decided by the physician based on the clinical evaluation. In case of otological (ENT) cause , management revolves around a combination of clinical resources. In case of failure of these, surgical management is considered.
Vestibular rehabilitation involves specific eye, head and body exercises to stimulate early vestibular compensation by early adaptation to the new functioning condition,substituting the reduced vestibular function with other sensorial information,vestibular habituation by reducing symptoms with repetitive exposure to stimuli.
Physical manoeuvres in case of benign paroxysmal positional vertigo are aimed at repositioning dislodged statoconial debris .
The manoeuvres are individualized based on clinical findings and patient factors.
Drug therapy is crucial to reach best results for most patients. Drugs resolve symptoms where other modalities are less effective. They enhance the resolution of associated symptoms,reduce the duration of illness and the recurrence rate. The disadvantage of drugs is the delay in vestibular compensation.
Surgery is considered when targeted clinical treatment fails. Conservative surgical approaches are preferred over ablative ones.One has to pinpoint the diagnosis before attempting surgery.
To conclude, vertigo being a vague symptom with lot of associations, the primary physician has to rule out critical causes at the earliest.
Once the etiology is narrowed down to vestibular cause management involves detailed interactive sessions with the neuro otologist. Management protocol is tailor made for each subject to promote functional recovery of body balance. The goal of treatment is to eliminate dizziness with associated symptoms, anxiety, physical insecurity, negative impact on quality of life and recurrences.