On 3 October, Sankalp Saxena, 31, was out shopping with his family in Jaipur when he felt his head spinning. He felt nauseous and was sweating profusely. It was so severe that he could not walk without support. He returned home, hoping rest would cure it. But it worsened. The next day he was admitted to a hospital, where he underwent a battery of tests. Everything was okay. Then, a neurosurgeon advised an MRI. When that turned out to be clear, he was referred to an ENT specialist who diagnosed vestibular neuritis, a type of vertigo that is caused by a virus infection. Saxena was prescribed medicines and asked to do some specialized exercises at home. He is fine now.
Till then, Saxena hadn’t heard of vertigo, though it’s quite common. If you’re suffering from this imbalance disorder, you essentially feel a sense of rotation, rocking, or the world spinning, even if you’re not moving, and it’s often associated with nausea, vomiting, sweating, a ringing sensation in the ear, difficulty in hearing and loss of coordination during walking. “The frequency of episodes may be once in few weeks to multiple times a day, depending on the underlining cause. The feeling lasts a short time but can be severe, and the symptoms usually last from a few minutes to hours,” says Rahul Gupta, senior consultant, neurosurgery, at the Fortis Hospital in Noida, near Delhi.
A report published in 2009 in the Seminars In Neurology journal says vertigo affects about 5% of the population across all age groups in any given year. Its prevalence increases with age and it’s about two-three times more common in women. It can happen to anyone and can start at any time. “This would translate to 60 million people in India. But the problem is that most patients do not know which doctor to visit, oscillating between ENT specialists, neurologists, orthopaedics, physicians. Also, most patients believe that vertigo does not have a cure and they have to live with it. Changing this mindset and educating patients that vertigo is curable is the biggest challenge,” says Anita Bhandari, consultant neurotologist at the Vertigo and Ear Clinic, Jaipur, and co-founder of NeuroEquilibrium Diagnostics Systems, which develops diagnostic systems for vertigo.
There are two types of vertigo—peripheral and central. Peripheral vertigo is caused by an imbalance in the inner ear which is responsible for maintaining a person’s balance, or due to a blockage in the vestibular nerve. Central vertigo happens due to disease or an injury to the brain, such as a head injury, illness or infection. “Vertigo could also be a symptom of another serious disorder; for example, those who have osteoporosis are more likely to have vertigo,” says Dr Gupta. In fact, a study published in 2009 in Neurology, the journal of the American Academy of Neurology, found that people who have osteoporosis are three times more likely to have vertigo. “The connection is possibly because a malfunctioning calcium metabolism is observed both in people with vertigo and osteoporosis,” explains Dr Gupta.
“Migraine headache and stroke, a condition where blood supply to a particular part of the brain is cut off, too, are among the known causes of central vertigo,” adds Dr Gupta. In addition, vertigo is a symptom which may be caused by various inner ear disorders, central nervous system disorders like multiple sclerosis and Parkinson’s disease, and could signify underlying psychogenic disorders as well. “People with a history of head injury and diabetes (the reason for the connection is not yet clear but an autonomic dysfunction could be the common factor in both) are also prone to vertigo,” says Dr Gupta.
“Diagnosis of the underlining cause of vertigo requires a battery of tests and, usually, a multidisciplinary approach by a panel of ENT, neurologist and psychiatrist,” says Dr Bhandari. “Medical history, a thorough physical examination, including looking into the ear and observing eye movements, specialized hearing or balance testing, and computerized tomography or MRI scans are common diagnostic procedures,” adds Dr Gupta.
If vertigo is not treated, it can lead to severe imbalance problems and cause sudden accidents. American Academy of Neurology guidelines state that many cases of vertigo can be treated with simple manoeuvres—a series of head and body movements performed by a doctor on a patient while he/she sits on a bed or table. “However, brain damage or cardiac problems may need to be treated differently with medicines (like anticholinergics, antihistamines and benzodiazepines, etc). Some people with severe infections could be prescribed steroids, antiviral drugs or antibiotics,” says Dr Bhandari.
Once the right treatment begins, healing is quick—as early as a week in some cases—so it’s important to diagnose it correctly.