KOCHI: Have you ever tried to look at surrounding objects when you’re on a moving train? If you shift your gaze after some time, you may feel like things are still moving and you feel like throwing up. Now, imagine having this feeling washing over you even while you and things around you are stationary. What if you feel it when you are lying down? Nothing can be worse than that. Many of us may be familiar with this dizzy feeling when getting up or lying down.
Such feeling of dizziness might imply vertigo, fainting, poor body balance, or even fits. Vertigo is a type of dizziness that makes you feel like you are spinning. This feeling may last from a few seconds to days and often worsens with movement. Vertigo is a common problem that affects about 15 per cent of the world’s population.
In India, around 180 million people reportedly suffer from balance and dizziness disorders. A healthy person never gives a second thought about how the body balances itself during daily activities. The balance and posture of our body are maintained by the coordinated signals from our brain, inner ear, specifically the vestibular system, eyes, spine and joints. Vertigo is commonly caused by disease of the vestibular system. Our ear is divided into the external ear, middle ear and inner ear. The vestibular system inside the inner ear helps sense the position of our head in relation to our body. It works in an integrated manner with the brain to maintain body position. Vertigo can result from diseases of the vestibular nerve or parts of the brain that deal with body balance.
Vertigo can occur in all age groups. However, the underlying causes often change with age. ‘Benign positional vertigo’ is a disorder of the vestibular system which often causes the most severe vertigo but can be treated easily. This occurs due to calcium carbonate particles trapped in the inner ear in the wrong position.
Vestibular neuritis is a viral infection of the balance nerve in which the patient experiences severe spinning with vomiting. It may last for a few days. Meniere’s Disease is caused by a build-up of fluid in the inner ear tubes, causing episodic vertigo with ringing in the ears and hearing loss.
Apart from this, stroke, brain infection, multiple sclerosis, hypothyroidism and other biochemical disturbances can cause vertigo even in the absence of fever. If it is a serious cause of vertigo, signs will include severe headache, double vision, problems with eye sight, sudden hearing loss, or early signs of brain stroke (weakness or numbness in arm or leg, face drooping to one side, trouble while speaking or swallowing). People who are over 60, with diabetes, hypertension, smoking and a history of heart disease or brain stroke, should be extra careful.
Vertigo is a symptom of the underlying disorder. It is not a disease in itself. There are around 40 major disorders that affect the inner ear and brain and cause vertigo. Besides these causes, certain systemic disorders and medicines can also cause dizziness. If the underlying medical disorder is left untreated, vertigo can hinder day-to-day activities and shake the person’s confidence.
Diagnosing vertigo
ENT specialists and Neurologists can diagnose and treat vertigo disorders with a detailed history and thorough evaluation. A person suffering from vertigo should get a vestibular evaluation at the earliest. Vertigo clinics offer a comprehensive evaluation of the balance system to identify the underlying cause of vertigo or imbalance. Detailed evaluation can be done by various tests like Dynamic Visual Acuity, VNG (Videonystagmography) and SVV (Subjective Visual Vertical).
Different diseases will require different treatment approaches. A patient with BPPV will require an evaluation to assess the status of the inner ear. This will be followed by repositioning manoeuvres specific to the type of BPPV to bring the displaced crystals back to the original position.
Patients diagnosed with vestibular migraine will require lifestyle and dietary modifications along with medical treatment, which will be decided according to age, sex, body weight, and any associated co-morbidity.
Patients with Meniere’s disease are treated with low salt and high potassium diet and drugs according to the severity of hearing and balance dysfunction. Often, patients with recurrent vertigo episodes have weakness of the balance nerve function. These patients will require Vestibular Rehabilitation Therapy for several weeks to help the nervous system develop compensatory strategies.
What to do?
If you suffer from a vertigo spell, try to sit or lie down to make sure that you do not fall. Do not panic. Try to understand if doing anything like turning the neck or getting up is worsening the spell. Look for signs like slurring of speech, blurred vision, double vision or headache.
Dr George is head of ENT department and Dr Tinu is an ENT consultant at Lourdes Hospital, Kochi