Vertigo and Balance
Vertigo is an altered sense of orientation. Patients may describe it in different ways like spinning, dizziness, giddiness, imbalance, rocking or feeling that they may fall. Vertigo can present as acute attacks or recurrent episodes.
Vertigo can be caused by many kinds of disorders of the balance system. Most commonly they are due to inner ear problems. Less commonly, central nervous system, systemic disorders like inadequately controlled BP or Diabetes or psychological disorders may be implicated. Amongst the commoner causes are disorders like Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s disease, Vestibular migraine, Labyrinthitis, Vestibular neuritis, head injury stroke, etc.
BPPV is one of the most common causes of vertigo. The full form of BPPV is Benign Paroxysmal Positional Vertigo. In this condition, the patient complains of spinning on getting up from bed or turning the head to certain positions. BPPV is caused by a displaced calcium carbonate crystals with the inner ear. It is treated by identifying the position of the crystals in the ear and repositioning them with specific exercises.
VNG or video nystagmography is an important test to evaluate dizzy patients. High speed infra red cameras are used to record eye movements in different tests. The tests allow the doctor to check the functioning of different parts of the balance system and their connections in the brain.
Vertigo can be caused by different diseases of the ear and brain. A complete evaluation will help to ascertain the cause. But some general instructions include avoiding _____, be careful in dark areas or stairs. Avoid alcohol and try to reduce your caffeine (Tea/Coffee) intake.
Vertigo is treatable ! Identifying the cause of your vertigo will help the doctor decide whether you require medicines or exercises to control your problem.
After a detailed history, the vertigo patient should undergo a thorough vestibular evaluation. This will include tests like Videonystagmography, Video Head impulse test, Subjective Visual Vertical and Dynamic Visual Acuity. Some patients may require an MRI of the brain. Audiometric tests to measure the hearing function should also be done.
Loud music or exposure to loud sounds can cause damage to the ear. However it is unusual for it to cause vertigo.
Vertigo is treatable ! A series of tests done by your doctor will help identify the cause of your vertigo. Once the cause is identified, treatment with medicines or rehabilitation exercises would be advised. Only in very rare cases, surgery is required.
Vestibular rehabilitation is very important to help dizzy patients recover their balance. It works on the principle of helping the brain develop alternate strategies to improve balance function. Vestibular rehabilitation exercises need to be tailored to work on the weak balance areas identified by the vestibular tests. They need to be progressively challenging to help the patient recover balance over several weeks.
Just as there is no one right medicine to treat vertigo; because vertigo is just a symptom. We would like to treat the cause of vertigo rather than suppressing its symptoms. For eg. Vestibular Neuritis in the acute stage is treated with steroids followed by vestibular rehabilitation. Vestibular Migraine requires migraine prophylactic drugs along with lifestyle modifications. Vestibular Paroxysmia is treated with carbamazepine. Thus treatment is given according to the disease. Vestibular suppressants like meclizine, cinnarizine, prochlorperazine etc. may be given in the acute stage for a few days. However, these medicines should not be given for more than 5 days as they will interfere with the recovery of the patient.
Most vertigo patients recover well with medicines or vestibular rehabilitation. However in some rare conditions, surgery may be required. This surgery is done by ENT surgeons or neurosurgeon & highly trained.
Stress is likely to aggravate vertigo caused by Vestibular Migraine. Some conditions like Functional Dizziness are more likely to occur in anxiety prone individuals.
Vertigo can affect people of all ages from young children to middle aged to the elderly. However the underlying cause of vertigo may be different in different age groups.
Vertigo is usually caused by inner ear disorders. Neuro-Otologists are specially trained to manage these patients.
The exercises prescribed for dizzy patients are called vestibular rehabilitation. The rehabilitation strategy needs to be planned according to the needs of the patient including area of weakness, age and associated disabilities.
Excessive screen time especially using moving screens (as in scrolling) or playing computer games can aggravate vertigo caused by Vestibular migraine.
Certain causes of vertigo can run in families like Vestibular migraine. A family history of vertigo, headaches and hearing loss should be looked for in patients complaining of vertigo.
Avoid driving if you feel dizzy ! During dizziness, the reflexes of the person may be affected which can compromise control over the vehicle.
If a dizzy patient has loss of ________, an urgent evaluation to identify the cause is required. Loss of consciousness may be associated with disease like stroke, epilepsy etc. and should be treated at the earliest.
Any defect in the balance system resulting in vertigo, unsteadiness or imbalance will affect the day-to-day activities of the patient and diminish the quality of life. It may cause a drop in the confidence of the patient as well as induce a fear of falling or movement. Treating vertigo will help restore the balance and confidence of the patient. The fear of movements may cause the patient to restrict themselves to a sedentary lifestyle and lead to depression or anxiety.
About 20–40% of the population is affected by dizziness at some point in their life. About 5% of the Indian population has vertigo. Most vertigo patients do not know what to do about their medical condition or even which doctor to consult — ENT, neurologist, ophthalmologist, orthopaedician, or physician, etc. Many patients believe that vertigo does not have a cure and that they have to live with it. Spread the word – VERTIGO IS TREATABLE !
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You need not suffer in silence now. You need not accept vertigo as ‘something you have to live with’. There is a way to cure vertigo, dizziness and any other balancing issues you are facing. Live a stable and vibrant life.
A Vertigo Free Life!