An intense attack of vertigo can, quite literally, lay you low. In many cases, the balance organs in your inner ear will quickly compensate and help you orient yourself, but in some cases vertigo can last hours, even days. It’s easy to confuse feeling faint or weak with true vertigo, cautions Dr. Devanand Jha, Consultant ENT Specialist and Head and Neck Surgeon, but a thorough investigation is always a good idea.
This is because vertigo is a symptom, not a disease –where a correct diagnosis might mean the difference between life and death for some.
Spinning around
“First we have to understand what vertigo is – it is the hallucination of movement,” says Dr. Jha. Derived from the Latin “vertere” meaning to turn, true vertigo is the result of a disturbance in balance or equilibrium. People experience vertigo differently – they might feel that they are the ones in motion (subjective vertigo) or that the room is spinning around them while they remain stationary (objective vertigo). Needless to say, both forms can be equally incapacitating and if one is driving or near an open fire, dangerous as well.
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| Pic courtesy getty images |
The balance we so often take for granted is a crucial tool for navigating our world. Beginning from the moment you turn your head, signals begin flowing to the labyrinth. Made mostly of bone and soft tissue and nestled in the inner ear, this organ composes three semicircular canals surrounded by fluid.
From the labyrinth, the information then makes its way to the vestibular nerve, which in turn carries the information to the areas of the brain which control balance and posture as well as motor coordination – the brainstem and cerebellum. Together they make up the vestibular system.
Vertigo can be classified as either ‘peripheral’ or ‘central’ depending on where the disorder is located in the vestibular system. 99% of the cases that Dr. Jha examines will fall into the category of peripheral, meaning that the problem lies in the inner ear. Only a small percentage will be central in origin – involving the central nervous system these might be associated with conditions like migraine, multiple sclerosis or even brain tumours.
Common forms of vertigo:
Vertigo is distinct from the dizziness brought on by alcohol or the faintness one feels after standing too long in the sun. It is also accompanied occasionally by nausea, sweating and abnormal eye movements. Did it strike when you were lying down or bending over? Did it last a few minutes or several hours? Is this the first time you are experiencing it? A doctor will have to take a thorough medical history that discovers the answers to these questions and more before he even begins the examination. “80% of the diagnosis can be made from taking the medical history alone,” says Dr. Jha.
There are many reasons why you might experience dizziness. Many of these diseases are also entirely curable, especially if caught in the early stages. These are some of the most common.
Peripheral:
Benign paroxysmal positional vertigo (BPPV) is among the most common causes of vertigo. These brief spells are commonly brought on by a movement of the head, but it is rarely serious and can be treated. Patients with BPPV are afflicted by what are sometimes referred to as “ear rocks”. These are particles that are dislodged from their space in the utricle which have over time found their way into one of the semicircular canals of the labyrinth, most often the posterior canal. Patients can be particularly susceptible to stress, lack of sleep and changes in barometric pressure, with an attack arriving on schedule a few days after rain or snow.
Dr. Jha helps BPPV sufferers reduce their reliance on medication by using a set of diagnostic and therapeutic manoeuvres as well. Here by rotating and manipulating the patient's head, the little particles can be coaxed back into the utricle. However this isn’t a definitive cure, he says, adding that most will eventually float back. But then, one need only repeat the exercise.
With Meniere’s disease, the sensation of vertigo might span several hours or even days. It is composed of a triad of symptoms, says Dr Jha, listing the episode of vertigo itself, ringing in the ears, and hearing loss. The condition is believed to be caused in part by the presence of excess fluid in the inner ear. For those with the condition, the onset of vertigo might be both abrupt and severe. Fluctuating hearing loss is also to be expected, as are periods in which the patient does not experience any of these distressing symptoms. Doctors often employ a combination of treatment techniques, including low salt diet, medications, intratympanic injections and vestibular training.
Labyrinthitis or inflammation of the inner ear might also result in a long spell of vertigo, accompanied by hearing loss. Bacterial or viral infections are among the most common causes of labyrinthitis. Though one can recover in a matter of weeks, patients with labyrinthitis might experience residual symptoms over the following months. Not surprisingly, in its acute stage, the condition can prompt panic attacks in sufferers.
Central:
Decreased blood flow to the brain can also trigger vertigo, says Dr. Jha. If this is caused by a tumour blocking vital pathways or by cerebellar hemorrhage, patients will often present other symptoms as well, including impaired motor function (many report difficulty in walking) and headaches.
An episode of vertigo might trigger a migraine and is also associated with multiple sclerosis. In the latter, the onset is usually abrupt.
Vertigo and ageing
It takes very little effort to imagine all the things that can go wrong should one have a spell of vertigo at the wrong time, but for the elderly, vertigo presents its own set of problems, says Dr. Jha. Fragile bones might break in a fall, worsening pre-existing conditions like arthritis, rheumatism or osteoporosis. In addition, the labyrinth, worn out after years of service, takes longer to recover. It makes sense then to take greater care – ask your doctor what kinds of activities may trigger or worsen your symptoms and request more information so that you can be prepared for any other related symptoms. Dr. Jha advises patients to avoid driving and cooking. Swimming might also be dangerous as cold water is known to stimulate the balance organs intensely, creating vertigo even in otherwise normal people.
In the end, he emphasises that vertigo must always be thoroughly investigated. Though it might be something easily corrected with a labyrinthine sedative, it might equally be a condition that needs urgent attention. Some diseases like the middle ear inflammatory and neoplastic problems may be eminently curable, hence every patient of vertigo should get a check- up done by the ENT Surgeon. |
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