Are you feeling Dizzy?

Are you feeling Dizzy?

Vertigo (giddiness or dizziness) is the feeling that you or your environment is moving or spinning. When you feel as if you yourself are moving, it’s called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo.

What keeps your balance?

Ear Anatomy

(3D reconstruction of inner ear.courtesy Dr Asha. FRCR. Travancore scans, Trivandrum)

The inner ear is innermost part of the vertebrate ear. It consists of the bony labyrinth, a system of passages comprising two main functional parts:
• The cochlea is for hearing
• The vestibular system keeps the balance
Your ear is one of the most important organ for your body-balance. We sense balance of our body on the principle of inertia of liquid in our organ of balance. In the ear there are semicircular channels.

Common causes of vertigo

• Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction. This type of vertigo is rarely serious and can be treated.
• Vertigo may also be caused by inflammation within the inner ear -labyrinthitis, which is characterized by the sudden onset of vertigo and may be associated with hearing loss and vomiting. The most common cause of labyrinthitis is a viral or bacterial infection.
• Meniere’s disease is composed of a triad of symptoms: episodes of vertigo, ringing in the ears (Tinnitus), and hearing loss. People have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free.
• Acoustic neuroma is a type of tumor on the 8th cranial nerve that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss. Cerebello Pontine angle lesions also present with similar symptoms. An MRI will show these lesions.
• Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person’s eyes gaze away from the side with the problem. Walking is also extremely impaired.
• Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose.
• Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache.

Investigations

If you have the following, you need to be seen and evaluated by ENT surgeon or Physician.
• Severe vertigo
• Headache , Nausea and Vomiting
• Hearing loss and Tinnitus
• Weakness and Difficulty speaking
• Abnormal eye movements
• Difficulty walking or controlling the arms and legs

After detailed medical history, full ENT, Neurological examination followed by Routine lab and ECG. An Audiogram is a must. CT scan or MRI is also mandatory.

Treatment

The choice of treatment will depend on the diagnosis.
• Specific types of vertigo may require additional treatment and referral:
• In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition. Vestibular rehabilitation exercises consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs.
• Particle repositioning maneuver is a treatment based on the idea that the condition is caused by displacement of small stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible People whose balance is affected by vertigo should take precautions to prevent injuries from falls.
• Those with risk factors for stroke should control their high blood pressure and high cholesterol and Diabetes.
• Patients with Meniere’s disease should limit salt in their diet.
Medications

Vestibular sedatives like Betahistine and Cinnarzine. Injection of Phenergan 25mg (Promethazine hydrochloride) will help alleviate the symptom very fast.
These medications should be taken only as directed and under the supervision of a doctor.

Dr Paulose is an ENT Consultant Plastic and Laser Surgeon with over 35 years of experience covering in Ear, Nose and Throat procedures, specializing in Laser Surgery and conventional medicine across India, U.K. and Middle East. He is currently engaged with the Jubilee Hospital, in Kerala, India.