Vertigo Treatment in Delhi, India

Derived from the Latin words, ‘vertere’ meaning ‘to turn’ and ‘igo’ meaning ‘condition’, vertigo is the faulty perception of the body, in relation to space. The surroundings seem to spin in rotational motion, while the body remains stationary. These episodes of dizziness may last for a few seconds or continue for days.

Causes of Vertigo

The impact dislodges the debris in the inner ear. This free-floating debris induces false movement signals in the brain.

Antidepressants, sedatives, hypertensive drugs and anticonvulsants may trigger spells of dizziness.

In certain cases, the exact reasons are unknown.

• Inner ear issues
• Benign Paroxysmal Positional Vertigo (BPPV) - Sudden changes in the head position cause displacement of calcium carbonate crystals in the inner ear (otoliths). This sends incorrect signals to the brain.
• Labyrinthitis - Inflammation of the fluid-filled channels (labyrinths) of the inner ear may trigger vertigo.
• Meniere’s Disease - Fluid accumulation in the inner ear generates a change in ear pressure, causing dizzy spells.
• Vestibular Neuritis - Inflammation of the vestibular nerve causes improper passage of sensory information to the brain, leading to vertigo.
• Cholesteatoma - Non-malignant cysts of epithelium erode bones behind the eardrum and cause vertigo.
• Head or neck injury
• Medication
• Idiopathic

Symptoms of Vertigo

• Feeling unsteady
• Sensation of rotation
• Nausea
• Vomiting
• Motion sickness
• Constant headache
• Ringing sensation in the ear (tinnitus)
• Repetitive, uncontrolled eye movements (nystagmus)
• Feeling of stuffiness within the ear

Stages of Vertigo

• Mild - The dizzy spells last briefly and go away on their own.
• Moderate - It is more symptomatic and requires the individual to lie still.
• Severe - Even after lying down, there is a sensation of constant movement. This is accompanied by nausea and vomiting.

Vertigo Diagnosis

Typical Tests for Vertigo

• Physical Examination:

A thorough Physical Examination is done, wherein the physician asks detailed questions regarding the episodes and symptoms.

• Posturography Test:

A Posturography Test is performed to assess your balance and posture control to determine how well you can maintain stability under different conditions.

• Vestibular Function Tests:

Several tests are conducted to evaluate inner ear function and balance, including:

• Fukuda-Unterberger’s test (stationary marching with eyes closed for a minute)
• Dix Hallpike Test (Making you lie down with head hanging at 450 and turned to one side for at least 45 seconds) for BPPV
• Rhomberg’s test (standing with feet together, eyes closed and open, with arms on the sides, for 10 seconds each) are carried out.

• Imaging Tests:

A CT Scan or MRI Scan may be performed to rule out structural abnormalities, brain lesions, or other neurological causes of vertigo.

1. Hearing, Vision, and Blood Tests:
   Additional tests for hearing, vision, and blood work are often recommended to identify any related conditions that might contribute to vertigo symptoms.

Differential Diagnosis of Vertigo

It’s important to differentiate vertigo from other conditions that may cause dizziness or imbalance:

• Vertigo should not be confused with acrophobia (fear of heights). Vertigo is a symptom that can occur as part of acrophobia but is not the same condition.
• Vertigo must also be distinguished from lightheadedness and imbalance, which have different underlying causes.
• Other medical conditions closely associated with vertigo include:
• Anxiety disorders
• Anaemia
• Multiple sclerosis
• Brain stroke
• Meningitis
• Brain neoplasms (tumours)

Vertigo Treatment

Vertigo treatment depends on the underlying cause and severity of symptoms. Common treatment options include medication, rehabilitation exercises, repositioning procedures, and, in rare cases, surgery.

1. Medication

Medications known as vestibular sedatives are commonly prescribed to help reduce dizziness, nausea, and balance-related discomfort. These medicines work by stabilizing the signals between the inner ear and the brain.

2. Vestibular Rehabilitation Training (VRT)

Vestibular Rehabilitation Therapy is a specialized exercise-based program designed to restore balance and improve stability.
It includes:

• Eye, head, and shoulder movement exercises (performed in sitting and standing positions)
• Gaze stabilization and focusing exercises
• Mobility and posture improvement exercises

These exercises help the brain adapt to inner ear changes, reducing vertigo episodes over time.

3. Epley Manoeuvre Or Canalith Repositioning Procedure (CRP)

The Epley Manoeuvre, also known as the Canalith Repositioning Procedure (CRP), is used mainly for Benign Paroxysmal Positional Vertigo (BPPV).
In this procedure:

• The patient’s head is moved through a series of specific positions to shift the calcium crystals (otoliths) within the inner ear canals.
• These movements reposition the otoliths to an area where they no longer cause abnormal balance signals, providing significant relief from vertigo symptoms.

4. Surgery

In severe or persistent cases where other treatments are ineffective, surgical intervention may be recommended.
Common surgical options include:

• Canal Plugging Surgery: Used to block the affected semicircular canal, preventing false movement signals.
• Microvascular Decompression Surgery: Performed to relieve pressure on the vestibular nerve when vascular compression is the cause.

Vertigo Prevention

Primary Prevention of Vertigo

• Avoiding Stress - Preventing anxiety attacks reduces the risk factors.
• Preventing Head Injury - Taking care to prevent falls and wearing a helmet while riding or playing sports, are of assistance.
• Lifestyle Changes - Regular exercising and preventing lifestyle diseases like diabetes, high cholesterol and hypertension, are beneficial.
• Dietary Considerations - Limiting salt intake, caffeine, sugary stuff, tobacco, and alcohol helps to ward off symptoms.
• Relaxation Techniques - Sleeping well, yoga, and tai chi are useful.

Secondary Prevention of Vertigo

• Self Treatment - Getting up slowly, avoiding sudden head jerks, sleeping with the head elevated, and squatting while picking something up, should be practised.
• Avoiding Certain Activities - It is best not to indulge in driving or climbing ladders if there have been dizzy spells in the past.
• Minimum Exposure To Bright Light - Steer clear of bright lights.
• Using Support - Use a cane while walking, to avoid unnecessary falls.
• Vitamin D Supplementation - Taking vitamin D and calcium supplements prevents recurrence of symptoms.
• Alternative Treatments - Herbal remedies and acupuncture techniques may help.

Risk Factors of Vertigo

• Migraine - Migraine is associated with spells of dizziness.
• Age - It is common in 70% of individuals aged above 65 years.
• Family History - Vertigo can be a symptom of hereditary syndromes.
• Past Instances - Previous episodes of dizziness are concerning factors.
• Medical Conditions - Diabetes, arrhythmia, ataxia, syphilis, and multiple sclerosis may trigger vertigo.
• Anxiety - Stress hormones (cortisols) are potential risk factors as they affect the vestibular system.
• Pregnancy - Hormonal changes during pregnancy may induce vertigo.

Possible Complications of Vertigo

Individuals with vertigo are advised against the handling of heavy machinery. Vertigo is linked to unexpected falls, which may lead to bone fractures and injuries. Severe cases are linked with paralysis of limbs, slurring of speech, irregular heartbeat and vestibular nerve damage.

Epidemiology of Vertigo

• Age - It is more common in individuals above 65 years.
• Gender - It is thrice more prevalent in women.
• Race - Studies show greater frequency in African-Americans and Asians, as compared to their Caucasian counterparts.
• Prevalence - It affects about 20% of adults annually. In India, BPPV affects about 107 per 100,000 yearly.

Expected Prognosis of Vertigo

BPPV has a recurrence rate of 50% in five years. Individuals with peripheral vertigo experience a recovery rate of up to 90% with the Epley manoeuvre treatment.

Natural Progression of Vertigo

Episodes of vertigo are sporadic and affect the quality of life, if left untreated. Mild cases may get better without treatment. If the underlying cause is not treated, it leads to long-term health complications.

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