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VERTIGO AWARENESS ARTICLE - DR. GEETA KOJU

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VERTIGO AWARENESS ARTICLE

 

DR. GEETA KOJU

MBBS, MS

(ENT)

 

Vertigo: is one of the chief complaints of ENT outpatients department. It is a sensation of feeling off balance. If you have these dizzy spells, you might feel like you are spinning or that the world around you is spinning or swaying from side to side. It is a kind of positional sensation or movement sensation of spatial position, accompanied by balance disorders. The cause of vertigo is complex, including multiple medical departments.

Patients often visit the department of neurology and orthopedics first. They do not know that the most common causes are vestibular diseases in the inner ear (about 50-70%) followed by intracranial diseases (about 20-30%). Therefore, ENT is the department where patients must first seek for the help. Of course the most severe vertigo occurs in neurology, intracranial hemorrhage and tumors that must also be excluded.

 

A large number of patients think that vertigo is more related to cervical disease, but modern studies have shown that cervical disc herniation and vertebral degeneration and hyperplasia have no significant impact on vertebral artery blood flow, resulting in very rare ischemic symptoms. Therefore, vertigo associated with cervical spondolysis is extremely rare clinical cause. Although imaging is very common in cervical osteoarthritis, it is blind and terrible to associate cervical spondylosis with all dizziness.

 

How do you know if your disease is in your head (central nervous system) or in your ear (inner ear vestibule)? Hearing tests, vestibular function tests, MRI, ENT examination, and neurologic physical examination are all essential. The most commonly used vestibular function test is the VNG {videonystagmography}. It can directly take eye-moving (nystagmus) video images and transmit it directly to the computer for processing. Through analysis of relevant information, we can generally understand the pathological changes of vertigo patients, affected ear sides, and possible causes and characteristic of the disease. Quantitative analysis helps determine disease progression, and prognosis. With the information provided by the VNG, can initially determine whether the cause of vertigo is from the "ear" or "head" origin.

 

Following are some commonly seen vertigo related diseases

BPPV: Benign paroxysmal positional vertigo

Benign- it is not life threatening.

Paraoxysmal-it comes in sudden brief spells

Positional- it gets triggered by certain head positions of movements

Vertigo-a false sense of rotational movement

It is also known as otolithiasis. This disease is the most common cause of vertigo and accounts for about 30% of all vertigo patients. The patient manifested vertigo during sudden rise, lying down, rolling over in bed, getting in and out of bed, tipping the head to look upward, bending over, bowing, etc., or quick head movement. The symptoms last for very short time (<1 min). Generally BPPV is without hearing loss, tinnitus and so on.

This disease is caused by the otoconia in the utricle of the vestibule of the inner ear falling off from their original position and entering the semicircular canal, causing an abnormal flow of internal lymphatic fluid. Therefore, the drug material has no effect. Only through the mechanical rotation of the head position, the detached otolith particles are returned to the original position and absorbed by the lymph fluid. This treatment is called repositioning maneuvor. Maneuvor differ according to the semicircular canal involved. (Most commonly affected is posterior semicircular canal). The treatment efficacy is up to 80-90%. Most of the patients get complete recovery with one episode of repositioning maneuvour. A very small number of people may need surgery. The disease can be confirmed by specific tests. The vestibular function test often shows the normal range.

 

Meniere’s disease:

The pathological change is increased endolymphatic fluid in the inner ear, and the cause is not clear. Incidence is more common in middle-aged people and less common in children under 10 years of age. The disease is characterized by recurrent vertigo, accompanied by fluctuating hearing loss, tinnitus, and ear fullnes as the main symptoms, which can be accompanied by nausea, vomiting, cold sweats, pale limbs. Deafness is commonly unilateral. During the initial attack of the disease, hearing loss can return to normal. About 10-20% of patients can affect the contralateral ear, causing bilateral deafness. Tinnitus is often worse before the onset of vertigo. Tinnitus can be relieved with early vertigo, and can persist after repeated vertigo attacks. Caloric test is generally the significant on the affected side.

 

Vestibular neuritis: This disease is a type of peripheral neuritis. The lesion occurs in the vestibular ganglion or vestibule. More than two weeks before the illness, there was a history of upper respiratory viral infection. Symptoms of vertigo can occur suddenly, and for a few days to months, which increase during activities. It is not associated with hearing loss, no complaints of tinnitus. Most patients experienced complete relief of symptoms within two or three months and almost no recurrence. It is a self-resolving disease. At the time of examination, there can be vestibular dysfunction with spontaneous nystagmus. No other symptoms of cranial nerve damage.

 

Sudden sensory neural hearing loss (SSNHL) with vertigo: More common in 30-50 years old, may be due to viral infection of the inner ear or vascular insufficiency. The patient experienced sudden onset of tinnitus and deafness. Some of these cases were accompanied by dizziness and vomiting. The condition was similar to Meniere's disease but SSNHL is not repeated. Hearing tests showed severe sensory neural hearing loss (more than 60db to 90db or above), and the vestibular function may be damaged accompanied by vertigo.

 

Causes of vertigo are many more such as: Labyrinthitis , vestibular migraine, alternobaric vertigo, motion sickness etc.

There are many central nervous system causes as well.

 

Therefore first we have to rule out the definite cause of vertigo and treat the disease accordingly.