Dr Anirban Biswas,
Vertigo& Deafness Clinic
BJ 252 Salt Lake Kolkata
Please know about certain myths and misconceptions that you may be harbouring in your mind regarding the symptom of head spinning (vertigo) or unsteadiness (imbalance) in case you are visiting our clinic for these problems. Understanding some basics will be helpful for you to seek treatment from us, and for us to offer treatment to you.
We will be grateful if you spare a few minutes reading this for our mutual convenience-
VERTIGO is not the name of any medical disease. It is NOT a disease in itself. Vertigo, very much like fever or pain is just the symptom or manifestation of some underlying disorder. The underlying disorder needs to be diagnosed and treated and this is exactly what we try to do here to the best of our ability. Our objective here is to find out i.e., diagnose / identify the medical disease that is causing the vertigo and only then treat the underlying disorder. The term ‘vertigo’ is the English translation of ‘matha ghora’ or ‘chakkar’. So if somebody has used the word ‘vertigo’ as the diagnosis of your ailment, it means that you have been wrongly informed and the symptom reported by you has been just translated to English and the disease has not been diagnosed. The medical person’s job is to identify and diagnose the disease that is causing the vertigo and not merely translate your symptom to English.
Your symptom may not exactly be head spinning, it may be a feeling of unsteadiness/ imbalance, or it may be a sinking sensation with or without a blurring of vision or a blackout, or it may be a persistent fear of falling or something else, or it may just be a loss of orientation. Try to report your exact feeling to us as precisely and as accurately as possible. We are in no hurry at all and expect the same of you. The very detailed and descriptive history and the chronology of the symptoms is vitally important for diagnosing the causative disease in all patients presenting with vertigo and/ or balance disorders. The duration of the episodes, any precipitating factors that you may know of, like any mental tension /anxiety or any change on head posture etc. that causes the giddiness, any accompanying features like hearing loss/buzzing sound in the ears, any weakness of the limbs, double vision, slurring of speech, loss of consciousness, any headache that happens during the vertigo are all very important inputs for diagnosis of the underlying medical disorder that is causing your symptom of vertigo/ imbalance. So please let us know all this to the best of your abilities. Do not feel irritated if we ask too many questions. Certain things that you consider unimportant may be of extreme relevance to us for the diagnosis.
Please know that about 40% patients who report to the doctor with the complain of vertigo/ imbalance do not have any organic disease or defect in the balance system. The problem in many such cases may be in other systems of the body; like, it may be a complete psychic sensation e.g., a panic attack, it may be due to low blood pressure and less blood reaching the brain, due to some cardiac disorders or due to some neurological conditions. Sometimes, it is a mixture of many things together. Please also know that disorders of the balance system have a cognitive and psychological impact that also needs to be identified and treated. Vertigo/imbalance is very often psychogenic in origin and there may not at all be any disorder in the balance (vestibular) system. Functional (psychogenic) dizziness is one of the three commonest causes of vertigo/imbalance. It is the doctor’s duty to diagnose it. Psychological evaluation and management in the form of counselling, cognitive-behavioural therapy and even psychiatric consultation is needed in quite a few patients of vertigo/imbalance.
Most, if not all of the drugs prescribed by doctors for vertigo/ imbalance are vestibular suppressants (anti-vertigo drugs) that merely sedate the balance system so that the head spinning is not felt by the patient. The current medical consensus is that such medicines should never be used for more than 3-5 days at the most and should preferably be discontinued within the first 1-3 days. These medicines do not actually address the underlying disorder that is causing the vertigo/ imbalance. They are just symptom-relieving medicines and are like crocin/ paracetamol in fever or pain. They only camouflage the symptom of head spinning but do not treat the underlying the disorder in any way. In patients presenting with imbalance / unsteadiness (not typical head spinning), the anti-vertigo drugs are dangerous as they sedate the balance sensors in the ears and hence the brain gets deprived of inputs from these balance sensors; this is expected to aggravate the imbalance and may even induce a fall. Surprisingly some patients with imbalance do even feel better with these vestibular suppressants. This is psychogenic as taking a pill for vertigo very often imparts a sense of mental security and complacency to the patient and patients feel that they will not get the vertigo but nothing can be further from truth. The worst part of these anti-vertigo drugs is that most of them actually jeopardise the natural process of restoration of balance which is ingrained / inherent in our biological system. You may be surprised to know that some of these anti-vertigo drugs that are rampantly prescribed for treating vertigo in India are not even approved by the FDA of the US.
The balance system is the most complex system in the human body and to identify and diagnose any disorder in the balance system most, if not all, patients need to undergo very sophisticated computerised tests called Vestibular Function Tests, which are pretty costly and require a lot of time and very sophisticated infrastructure. These tests are VNG, VHIT, cervical and ocular VEMPs, SVV, DVA, fHIT, Stabilometry /Posturography and some audiological tests like ECochG, BERA, Audiometry etc. The tests are required not only for diagnosing the status of the balance system and the underlying pathology causing the head spinning/ imbalance, these tests are essential also for determining the exact line of treatment both medical treatment as well as physical therapy. Very costly instruments and very well trained and dedicated personnel are required to carry out these tests and they are best done under strict medical supervision in front of a medical person well versed in the nuances of the balance system. Medical personnel who have a very thorough understanding of the intricacies of the balance system are the right persons to interpret and make reports of the vestibular function tests. Tests done and reported by non-medical persons are usually, if not always found to be absolutely erroneous and are unacceptable. Though CT scans and MRIs are sometimes necessary, they are not the primary investigations in balance disorder patients. Balance disorders are mainly diagnosed by the Vestibular Function Tests provided of course that they are done correctly in proper well-equipped set-ups. The results have to be analysed by medical personnel with insight in balance disorders in relevance to the history, the presenting features and the clinical findings for a proper diagnosis. Just the tests alone do not mean anything.
Complete management / treatment of balance disorders is usually not possible just by taking some medicines only. Most disorders in the balance system require diligent physical therapy called VESTIBULAR PHYSIOTHERAPY which has to be carried out under the guidance of trained neuro-physiotherapists who are experienced in handling balance disorder patients. Special equipment made specifically for stimulating the balance system is often required for this. Treatment of vertigo/ imbalance is never complete without physical therapy in most cases. Medicines can at best reduce some symptoms and contain the disease but for restoration of balance, proper physical therapy is a must in many if not all patients presenting with balance disorders. Special forms of physical therapy like Yogic asanas and Taichi if carried out under the guidance of qualified experts are often very effective in restoration of balance. A right mix of vestibular physiotherapist under the guidance of a trained neuro-physiotherapist in combination with specific yogic asanas and Taichi are very effective in restoring balance in a lot many
Cervical spondylosis is one of the rarest causes of head-spinning and most specialists in balance disorder believe that cervical spondylosis is never a cause of vertigo. Hence, whether you have cervical spondylosis or not is irrelevant in the diagnosis and treatment of vertigo/ imbalance. Similarly, hypertension (high BP) and flatulence (colloquially called ‘gas’) is also not a known cause of vertigo. They may be there as co-morbid conditions but per se does not cause head spinning. On the other hand many metabolic disorders like diabetes, thyroid disorders and many neurological disorders and many psychological disorders can cause balance problems. Hence, some patients may require neurological / psychiatric referral.