A study reveals that 30% of adults in the sixth decade of life and 50% above 80 years experience dizziness.¹ Vertigo dulls the spark in life and scares us.

Understanding vertigo

We are left with a feeling of being shaken vigorously as if overturned and having a spinning sensation, which is vertigo.

There are four types² of dizziness:

• Vertigo
• Lightheadedness
• Presyncope
• Disequilibrium

Vertigo is the most common disorder of spatial orientation and motion perception (In simpler words, a feeling of the room spinning around), and this unsteadiness affects a stable gaze, posture, and gait.¹ The spinning lasts from a few seconds to a few hours and is more severe than dizziness.

How the body balances 

Multiple organ systems help to balance the human body. It is achieved by ears, muscles, joints, eyes, and brain all working in synchronicity.

Ears have structures embedded in them for balance; muscles and joints have receptors to sense position; eyes have visual sensation. All this required information by the organs reaches the brain. The brain processes this relevant information and helps us stay upright and steady.³

Causes

There are two causes-  peripheral and central.

Peripheral causes

These arise within the ear or vestibular nerve (the nerve that transmits information about position and motion) connecting the inner ear to the brain stem.

Benign paroxysmal positional vertigo (BPPV) occurs when calcium particles clump in the ear canals. They disrupt balance signals, and an imbalance occurs.

Meniere’s disease occurs due to increased pressure within the ear canal due to accumulating fluid. It causes vertigo and other symptoms, such as hearing loss, and tinnitus (ringing voices in the ears).

Vestibular neuritis and Labyrinthitisare viral infections of the nerves that cause inflammation which precipitates vertigo

Central causes

They involve the brainstem that processes signals from the inner ear. In conditions like stroke, blood flow to the brain is interrupted, causing vertigo with other symptoms such as multiple sclerosis, brain tumours and migraines

Symptoms

Common symptoms of vertigo are

• Dizziness
• Fall, 
• Gait disturbance. 

Associated symptoms²

Peripheral causes are:

• Hearing loss
• Pain
• Nausea
• Vomiting

In the case of central cause due to cerebrovascular causes, tumours and associated symptoms like nausea and vomiting are less severe.

The associated symptoms due to the central cause are:

• Weakness
• Dysarthria (difficulty in speaking because of weakness in speech muscles)
• Vision and hearing changes
• Paraesthesia (tingling)
• Altered levels of consciousness
• Ataxia (no coordination in movements)

Vertigo due to migraine may have the additional feature of photophobia.

Risk factors

Elderly individuals have comorbidities and have to depend upon different therapies, which cause vertigo.

Previous experiences of vertigo increase the susceptibility to recurrent episodes.

Changes in blood pressure

As people age, the heart’s ability to pump blood efficiently declines. The fall in blood pressure causes spinning and light-headedness that lasts for a short time. Once the blood pressure reaches 120/80 dizziness disappears.

Iron in blood

The haemoglobin present in the blood combines with oxygen dissolved in the blood and transports it to all parts of thin the blood combines with oxygen dissolved in the blood and transports it to body parts.  Low iron levels reduced oxygen-carrying capacity and cause dizziness.

Blood sugar level

Hypoglycaemia is lowered blood sugar and causes dizziness accompanied by sweating, and anxiety.

Medications

Antidepressants, anti-seizures, tranquilisers, and sedatives also cause vertigo.

Neurologic conditions

In diseases like Parkinsonism and multiple sclerosis, the body undergoes changes that cause spinning.

Surviving challenges and the aftermath

Anxiety, depression, and social isolation are what remain after a fall. Dehydration and malnutrition occur commonly in the ageing population. These further compound their travails and aggravate the challenges.

Vertigo strikes them off to imbalance and causes a fall which results in injuries and fractures.

Injuries cause immobility and loss of independence. They always fear a subsequent fall. Sudden falls may turn life-threatening.

Lifestyle changes

Recurrent episodes warrant a few cautions:

• Be aware of the possibility of recurrence
• Avoid sudden movements
• For stability, use walking sticks
• Making the home fall-proof, removing rugs, and using anti-skid mats in the bath and shower
• Have good lighting
• Lie down flat on feeling dizzy
• Avoid driving any vehicle
• Avoid stress
• If dizziness is due to medicine, consult your physician

Dietary modifications

• Avoid foods with high salt and sugar content
• Eat fresh fruits and vegetables
• Be adequately hydrated
• Avoid coffee and alcohol
• Keep yourself hydrated
• Avoid alcohol
• Avoid tobacco because it constricts blood vessels

Some common myths 

Common misconceptions about vertigo are:

1. As the ear controls the balance, most people associate vertigo with the ear. There may be other problems which can cause spin bouts. A chronic problem deserves attention
2. Home remedies such as cleaning the wax can solve problems. At times, removing wax from the ear damages the eardrum
3. It is presumed to be an imaginary problem, a problem created in an individual’s head
4. Ignore it since there is no long-term solution for it

Treatment⁴

Treating the underlying cause forms the basis of all treatment methods.

Medications

Disease-specific medications are needed to avoid episodes of vertigo. Medicines prescribed to treat vertigo are antiemetics (those that prevent vomiting and nausea), diazepam, alprazolam and antihistamines.

Balance exercises

There is a need for the ageing and those with Parkinsonism to begin these exercises early so that they have independent activities for a longer time.

Early observation and correction of changes in posture and steadiness earlier in life help them to manage daily challenges effectively.

Head position movements or canalith positioning under professional care helps to alleviate Benign paroxysmal positional vertigo (BPPV) symptoms.

Surgery

When medical treatment fails surgery may be necessary. Surgery aims to correct (repair and stabilize) inner ear function to provide balance. It stops generating unnecessary information to relay to the brain.

Though done for corrective purposes yet, it is considered destructive.

FAQs

Is Vertigo dangerous?

Vertigo causes dangerous falls.

What is BPPV?

Benign paroxysmal positional vertigo, a common cause of dizziness, occurs when changing positions, getting up, lying down or turning.

What is the treatment for vertigo?

Address the underlying cause with medications, vestibular exercises, or surgery (if needed).

How do we avoid balance problems?

Self-care is essential to avoid balance problems; stay active, eat well and take your health check-ups regularly.

Summary

It is not unusual for people to feel dizzy. At times; there may be many other reasons for its occurrence such as inner ear problems, neurologic problems or new medications that just started

Vertigo can lead to falls, falls can lead to injuries and even death.