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Oman Health: Dealing with Vertigo
January 14, 2017 | 4:41 PM
by Hilmi Abdul Salam
Therapies to manage vertigo include head position manoeuvres, balance therapy, and psychotherapy
 
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Having right balance is essential and for this complex integration of sensory information regarding the position of the body, the ability to generate appropriate motor responses to control body movement is required. Systems involved are vision, vestibular sense (inner ear), sense of position, muscle strength, and reaction time.

Dizziness is a subjective term; nobody other than the patient can experience what that person is experiencing. Many people with this disorder are inadequately evaluated. For some people, dizziness or vertigo is a feeling of unsteadiness, with the experience that the whole room is spinning around them.

Dizziness or vertigo can affect a person’s independence, ability to work, and their quality of life. Many times I have patients who cannot explain their exact feeling, but they just know there is something different. A lot of people say they feel dizzy, but what they are actually feeling is an unsteadiness on their feet. Dizziness and balance disorders may also lead to other problems including fatigue, difficulty walking, depression, or disinterest in everyday activities.

Generally, if someone has feelings of nausea, wooziness, and a sensation of spinning, it is usually referred to as vertigo. With increasing age there could be a progressive loss of function of these systems due to normal ageing or to a specific pathology affecting a particular component. Studies say that approximately one in five elderly people experiences dizziness or balance problems, associated with positional instability, and tendency to fall, spinning, and floating sensation. Factors such as diabetes, hypertension, hypercholesterolemia, hypertriglyceridecmia, and thyroid disorders do not help it either.



Vertigo is a symptom of several different conditions. There are two types of vertigo, known as peripheral and central, depending on the cause. Since many types of vertigo go away without treatment, initial evaluation by a general practitioner or family doctor is appropriate early on, reserving specialty care for chronic cases.

A combined approach, involving Otolaryngologist (ENT), Ophthalmologist, and Neurologist for a detailed evaluation and assessment is advised. It is extremely rare, but not impossible, for young children to have vertigo. It becomes more common in the early 20s and affects all ages commonly after that. Its consequences however become more substantial as you get older because loss of balance in the elderly commonly leads to major fractures.



Can the symptoms of vertigo be confused with the symptoms of other diseases or conditions?

This is a common occurrence. Usually they are mistaken because of use of the word dizziness. Dizziness can refer to lightheadedness, which is not vertigo and is commonly produced by vascular problems. Dizziness also can mean vertigo, and there are very few causes of vertigo that do not come from the inner ear. Occasionally, rare types of strokes can cause vertigo, but these are usually associated with other neurological symptoms as well.

Is dizziness the same for all people?

For some people it is lightheadedness. Some people feel faint. Some feel as if they are moving when they are not. Others feel a spinning sensation in which either they are doing the spinning or the world around them is spinning. For people over the age of 65, dizziness is one of the most frequent reasons for physician visits and hospital admissions. Dizziness is actually the second most common complaint reported to a physician next to back pain.

Is there any treatment for dizziness?

Treatment for dizziness varies according to the diagnosis. Depending on the underlying cause, treatment options may include medication, changes in diet, physical therapy, or even surgery in the most severe cases.

Are there any surgical procedures to correct vertigo?

There are surgical procedures to correct certain types of vertigo. If the vertigo is caused by a disease such as Meniere’s disease, where the function of the involved ear changes over time, and these changes do not respond to medical therapy, then surgical intervention may eliminate the vertigo.

How does physical therapy help?

In forms of vertigo, where the inner ear has suffered damage and the function of that ear is fixed, not changing over time, physical therapy can be quite helpful. The reason physical therapy is helpful is that it helps train the brain to compensate for the loss of function in the ear.

What kind of physical therapy works to reduce vertigo?

It’s called vestibular rehabilitation. Not all physical therapists are trained in the practice. Common exercises include moving the eyes from side to side and rotating the head from side to side.

Is anxiety associated with vertigo?

Vertigo causes extreme anxiety in most people. Anxiety, by itself, does not produce vertigo. However, in association with conditions that do produce vertigo, anxiety can make the vertigo much worse. People with certain anxiety disorders such as panic attacks can sometimes also experience vertigo.

Can a child get vertigo from playing a video game?

Three-dimensional video games can cause a brief sensation of vertigo, but it would not persist. Mental stress can make many forms of vertigo worse, but will not, by itself, produce vertigo. Positional vertigo refers to when a change in the position of your head produces a sense of vertigo.

How do doctors treat vertigo?

Diagnosis of most vertigo disorders is based on meticulous history taking and one’s experience in the field of neuro-otology. Some use the technique of elimination. If all fails, there is plan B consisting of diuretics, antivert, anti-nausea, anti-anxiety, anti-migraine, etc. Therapies including head position manoeuvres, balance therapy, and psychotherapy have been successful in managing many dizziness. Surgical and destructive procedures should be opted when all roads have failed and dizziness is debilitating. Always opt for second or third opinion before surgical intervention is adopted.

Dizziness usually goes away on its own. If it doesn’t, consider the following tips:

• Be aware of the possible warning signs before dizziness, which can lead to fall and serious injury. Avoid moving suddenly or driving, use cane if needed.

• Make your home fall-proof home by removing tripping hazards.

• Sit or lie down immediately if feeling dizzy. Lie still in dark room.

• Avoid driving a car or operating heavy machinery.

• Avoid caffeine, alcohol, salt, and tobacco.

• Drink enough water, eat healthy, sleep well, avoid stress

• Discontinue medication that cause dizziness.

• Consult an Otolaryngologist or an ENT.

Dr Hilmi Abdul Salam, is specialist – ENT at Burjeel Medical Centre, Azaiba

- [email protected]

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