In our previous post we saw what causes vertigo and the different types of vertigo. In the current post we shall delve into its treatment. Firstly, we must understand that vertigo is only a symptom and it is the underlying disorder that needs to be treated. So, it is important to diagnose it before you take anti-vertigo tablets blindly. While many a times the spinning resolves on its own, some patients require prompt treatment to alleviate their suffering due to vertigo.
WHAT IS COMPENSATION? DOES VERTIGO GET BETTER WITHOUT TREATMENT?
When one ear is affected causing imbalance, the other ear tends to compensate for the loss of function. How the body accomplishes this is not clearly known. The compensation by the unaffected side is quite effective. After a few days of rest, patients often find that their vertigo has disappeared. Sometimes, the affected side might have got healed on its own.
But this is not the case always. Certain disorders need strong measures without which the patient may not even be able to lift up his head from bed. We encourage our readers to consult us immediately when they develop vertigo symptoms so that they don’t ignore anything sinister.
how does one diagnose vertigo? what tests can be done?
Vertigo patients usually go to ENT specialists or neurologists. The ENT deals with peripheral causes, especially inner ear related, whereas the neurologist handles the central ones. We would like to tell our readers that a whole lot is dependent on the history you give to your doctor. Therefore, we encourage you to remember all details if at all you suffer an episode of vertigo.
The details sought by the doctors are generally like-
- Number of episodes
- How long does an episode last?
- Is there any spinning or only weakness?
- Do head movements trigger the reeling?
- Does hearing reduce during an episode or after?
- Any ear fullness?
- Is there any warning symptom before the episode?
- Details of the first episode
- What makes the dizzy feeling go away?
- Any ear discharge?
After taking a thorough history, the doctor will do a routine ENT examination. Then, he will test your cranial nerves, balance and hearing. So the doctor may ask for a pure tone audiogram. This test shows hearing capacity in each ear. The tests to check for balance will involve a few maneuvers followed by looking for jerky eye movements. In addition to that, video-nystagmography, caloric testing and posturography tests are done for more details.
dix hallpike test
This is a special test to diagnose BPPV. BPPV is benign paroxysmal positional vertigo. We saw in our previous post how this disorder arises. We perform the test in the ENT office itself. If the patient shows jerky movements of the eye when head is moved in a particular fashion, we take the test as positive. After BPPV is diagnosed, we give a reversal maneuver in the same sitting. This is called Epleys maneuver.
MRI scans of the brain with details of nerve of hearing and balance help in further diagnosis. It picks up certain conditions like acoustic neuroma and abnormal blood vessels inside the brain.
what medicines to take during an attack of vertigo?
There are many types of medicines for a vertigo. The commonest medicine that we take, often by ourselves, is Vertin (Betahistine). Firstly, there are medicines which suppress the functions of the vestibular system (balance). Secondly, we use antihistaminics like cinnarizine (Stugeron). Thirdly, prochlorperazine (Stemetil) is used in an acute episode. Keep it under the tongue to relieve reeling. Lastly, you have medicines that suppress the whole central nervous system.
Vertigo medicines are profusely available in the market. However, you must understand that, most of these suppress your balance system and hide the cause which caused the spinning. The diagnostic tests show negative results with these medicines. We, therefore, encourage our readers to contact us before they self medicate.
what exercises help in vertigo treatment?
Exercises for vertigo management are of two types. The first is for repositioning the calcium crystals inside the ear. The second is for rehabilitation of the balance system.
In the first type, a series of movements replace the calcium crystals into their original place. This removes the blockage to inner ear fluid movement and cures vertigo. This is the choice of treatment for BPPV. Brandt Daroff exercises, which you can do at home, help clear BPPV.
In the second type, the exercises help the body accustom to the reduced functioning of the affected side. They also help bring compensation from the unaffected side. Cawthorne Cooksey exercises, usually given to patients in the form of a pamphlet, is very common.
is there surgery for vertigo?
Surgery can treat intractable cases of vertigo. Often it involves ablating the balance system in one particular side. This is achieved by destroying the nerve inside the ear. The most important after effect is the loss of hearing on that side. Therefore, we reserve this method when all the other methods fail. Recently, scientists have come up with methods to selectively destroy the nerve responsible for balance, preserving hearing function.
home remedies for vertigo? what lifestyle changes will help?
Certain steps help reduce the effects of vertigo. They are as follows:
- Sit down when your head starts reeling.
- Lie down in a dark quiet room when the spinning is severe.
- Squat to lift something from floor or lower shelf rather than bending down.
- Take particular care while getting up from bed or turning your head.
- Avoid sudden jerky head movements.
- Perform very slowly those movements which trigger the vertigo.
- Turn on the lights when you get up to pee in the nights.
- Use a walking stick or cane.
- Avoid excess caffeine, salt, carbonated drinks, alcohol and food with a high content of sugar
- Make sure you got no nutritional deficiency
Talk to one of our specialists to know more about what dietary and lifestyle modifications you can make.
treatment of central vertigo, meniere’s disease and vertigo due to ear infections.
Like we discussed before, the treatment for vertigo is varied. Meniere’s disease produces sudden severe vertigo associated with hearing loss. The patients are able to predict an attack. We put these patients on long term medicines, like Beta-histine. If the repeated episodes have caused significant hearing loss, we give a hearing aid also. Lastly, we give medicines to either relieve an acute episode or to prevent further episodes.
Middle ear infections which produce vertigo are an indication that the disease is eating away the bone to enter the brain. You need to get operated soon. The ENT specialist asks for a high resolution CT scan in this scenario.
Treatment of central vertigo and vertigo due to an unknown cause is difficult. An MRI scan is very helpful to rule out any lesion inside the brain. Neurologists and audio-vestibular physicians take over in such cases.
Some patients need more than just the routine measures. In them we try and rule out any emotional or psychological cause for the symptoms. A lot of elderly patients complain of vertigo where as, in actual, their problems are due to weakness, anxiety and depression. Appropriate measures directed against these will relieve the vertigo.
Cognitive behavioral therapy is helpful in chronic vertigo of unknown cause. This immensely benefits the patients who learn to tolerate the symptoms and lead better lives. Nextly, acupressure and acupuncture has proven helpful in some. Finally, one may register in vertigo support groups. These groups play an important role in helping patients to come up with specific ideas and help alleviate their symptoms.
TREATMENT OF VITAMIN DEFICIENCIES WHICH CAUSE VERTIGO
Deficiency of Vitamin B12 and D are known to produce symptoms similar to vertigo. B12 is an important vitamin for the optimum functioning of nerves. Its deficiency can cause weakness and trouble walking. B12 vitamin is not obtained from a plant based diet. Incorporate animal foods like eggs and dairy products to get your daily dose of B12. Secondly, Vitamin D deficiency is related to BPPV. Studies have shown that correction of vitamin D deficiency and their supplementation helps prevent recurrence of BPPV and heal it faster.
The diagnosis requires that one rules out other common causes. Certain neck exercises can produce vertigo. This type of vertigo occurs due to thickening of neck vessels or their abnormal compression by bony projections. Treatment involves correction of the deformity if severe or to avoid precipitating movements of neck. Stretch exercises, exercises to improve range of neck motion and muscle relaxants help lower it. We suggest our readers to check up with their primary doctor before starting any head and neck exercise if they are prone for dizziness.
I would like to thank Mr. Chandra Mohan Agarwal for his valuable contributions to this post. Mr. C. M. Agarwal retired as the Managing Director of Tilam Sangh. Prior to that he worked for the Rajasthan Accounts Service.
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