Frequently patients’ complain of dizziness and other sensations of imbalance. They may be early symptoms of serious neurological disorders, but most are benign. Especially in elderly persons with other neurological deficits and chronic medical problems risk of falls due to dizziness is higher.
Dizziness is a vague and broad term used by patients to describe their symptoms. A careful history helps to understand exactly what a patient is experiencing and helps distinguish between Vertigo, Lightheadedness, Pre-syncopal symptoms, etc., which may be due to either inner ear, central nervous system (CNS), cardiovascular, or other systemic diseases.
How common is it?
Although 5-10% of the population experience Dizziness, Vertigo, and imbalance, in patients older than 40 years it is seen in nearly 40% of them. The risk of falling is about 25% in the over 65-year population. It is also more common in women.
What is Vertigo?
Vertigo is a symptom rather than a condition in itself. It is an illusion of movement and is commonly due to an inner ear problem. It is also described as a sensation that you, or the environment around you, is moving or spinning and is usually associated with nausea and vomiting. It may be barely noticeable or may be so severe making normal life very difficult. It usually develops suddenly and can last for a few seconds, or much longer and last for several days.
Other symptoms associated with vertigo may include loss of balance – which can make it difficult to stand or walk; lightheadedness/dizziness/feeling faint; ringing in your ears (tinnitus); hearing loss; a feeling of fullness/pressure in the ear; headaches; nystagmus, in which the eyes move uncontrollably, usually from side to side.
What causes Vertigo?
True Vertigo is commonly caused by a problem with the balance system in the inner ear, brain, or sensory nerve pathway.
Some common causes of vertigo may include: Benign Paroxysmal Positional Vertigo (BPPV) – head movements trigger vertigo; Vestibular migraine – Migraine causing vertigo; Labyrinthitis – an inner ear infection; Vestibular Neuronitis – inflammation of nerve which connects balance organ to brain; Vestibular Schwannoma/Acoustic Neuroma – benign tumour on the vestibular nerve; Meniere’s disease; Central causes (involving the brain and nervous system); Mental health issues, Psychiatric problem; Some medicines that act on the brain/central nervous system, etc.
How is Vertigo diagnosed?
It is commoner in the elderly, but due to their underlying medical disorders and medication, it is difficult to obtain an accurate diagnosis. In the younger patients, however, a more careful and thorough investigation is needed as it may represent more serious disease.
A detailed history and clinical examination, along with additional tests such as audiometry, vestibular tests, blood tests, computed tomography (CT), and magnetic resonance imaging (MRI) need to diagnose the cause.
The most commonly performed vestibular tests are as follows: Electro/videonystagmography (ENG); the rotating-chair test; Computerized dynamic posturography (CDP); and Vestibular-evoked myogenic potentials. Since most abnormalities detected by vestibular testing can be identified by a carefully conducted clinical examination in the clinic, their routine use is probably not cost-effective.
How is Vertigo treated?
Vestibular suppressants, and antiemetic medications and in some patients Steroids are useful in treating acute symptoms. A wide variety of medicines such as antihistamines, benzodiazepines, phenothiazines, monoaminergic agents, and anticholinergic agents have been used to provide symptom control. It is advisable to use vestibular suppressants only for a few days so as not to delay the brain’s natural compensatory mechanism for peripheral vertigo. Vestibular rehabilitation is very useful in boosting central vestibular compensation. It is different from traditional physiotherapy for gait and balance disorders. Vestibular rehabilitation can be performed by patients at home using tailored exercises e.g. The Cooksey Cawthrone exercises, that focus on challenging the main vestibular reflexes (VOR, VSR) and visual interaction with both reflexes.