Have a question about balance? We asked an expert to answer them all

Dr. Santosh Kumar Kackar – former director of the All India Institute of Medical Sciences and celebrated Neuro-Otorhinolaryngologist who pioneered the study of balance disorders in India – tells us all there is to know about vertigo

Updated: October 9, 2019 3:17:16 pm
Vertigo could very well be the harbinger of a stroke if it isn’t addressed in time.

After completing his post-graduate degree in Otorhinolaryngology from King George’s Medical University, Lucknow, Dr Santosh Kumar Kackar began his practice and in-depth study of balance disorders. He even went on to secure a fellowship from the Royal College of Surgeons, London. In 1964, along with other notable doctors like Dr. Y. N. Mehra, he opened India’s first-ever Neuro-Otorhinolaryngology clinic, which essentially dealt with studying and treating balance disorders like vertigo. Until then, not much was known about this affliction in India. He went on to publish his medical research findings and was awarded the Padma Shri in 1986. While he may be retired, his endeavour to bring balance back into people’s life continues. He still practices from home and charitable hospitals. So, this World Balance Awareness Week, we couldn’t think of anyone better to enlighten you about balance disorders.

Vertigo and dizziness are both balance disorders. What is the difference?

Not many are aware of the difference between vertigo and dizziness. Patients often confuse one with the other. Dizziness is usually light-headedness, where one feels faint. Vertigo, on the other hand, is a disordered orientation of the body in relation to space. Meaning, your brain is getting the wrong signal about your movement. You could be sitting on a chair, and you’ll feel like the chair is rotating. You could be standing, and you’ll feel like the room is spinning.  It is a sort of hallucination or a false sense of movement.

When must one seek medical help for vertigo?

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A vertigo spell can happen to anyone. But when you have repeated attacks that last longer, and you experience nausea, loss of hearing, noises within the ear, the fullness of the ear where it feels like there is water or fluid collecting, headaches, loss of consciousness or a loss of sensation in the arm, then consult with a doctor immediately. Vertigo could very well be the harbinger of a stroke if it isn’t addressed in time.

Who in your opinion is most likely to suffer from this condition? 

People above the age of 60 have a higher chance of getting vertigo. Children rarely complain about imbalance. But when a child does, one needs to look for a brain tumour. Sometimes pre-menopausal women who experience hormonal imbalances and women during pregnancy who may have gestational diabetes and hypertension can feel vertigo. During my tenure as a doctor, I’ve treated more men than women for vertigo. Having said that, it can happen to just about anyone.

How do you determine whether a person is suffering from vertigo? 

Most people in India complain about chakkar. They aren’t very clear about their problems. We as medical practitioners then need to see what they mean by chakkar. We usually begin with the patient’s medical history. This helps you determine vertigo in a majority of cases. Questions like, how did it start? How often do the attacks happen? How long did it last? Was it accompanied by a headache? Does the patient have a history of diabetes or hypertension? Has he had a head injury? Is there any ear discharge or pain? Did he become temporarily unconscious? Does the room spin? Did he see dark spots? Once we have the answers, we do a series of examinations. We check the ear and eardrum. We look for abnormal eye movement and facial deformities. We also conduct exercises to see if the patient’s hands and legs are well coordinated. We check to see whether he can stand properly for one minute with his eyes closed and hands stretched out, whether he can walk without feeling like he’s going to fall. We then put the patient through investigative tests like MRIs, CAT scans, blood tests, and audiometry tests to determine the causes.

What are the causes of vertigo?

It helps to know that vertigo is not a disease but a symptom. There are many causes, but broadly speaking, one can divide the causes under two umbrellas:

  • Generalized causes: These include diabetes, hypertension, multiple sclerosis, autoimmune diseases, hormonal changes, anxiety, and pre-menopause, amongst others.
  • Localized causes: These refer to specific problems that occur in the brain, spine, and ear. They can include a perforated eardrum, tumours in the brain, spine or ear, cholesteatoma (a benign growth that develops behind the eardrum) and cervical spondylitis to name a few. If it is a localized issue with a pure vertigo complaint and no other health issue, then it is most likely caused by Labyrinthitis (an ear infection or a respiratory infection that infiltrates the inner ear), neuronitis (the infection of the vestibulocochlear nerve), BPPV (benign paroxysmal positional vertigo, which is triggered by posture) or Ménière’s syndrome (a fluid build-up in the ear).

What is the prognosis of vertigo?

The prognosis is extremely subjective and heavily dependent on what’s causing vertigo. The treatment of the cause will play a key role in managing vertigo. While vertigo caused by diabetes and hypertension has a better prognosis (if managed well), aggressive tumours that tend to come back don’t have such a great prognosis.

How does one treat vertigo?

The primary line of treatment is addressing and correcting the cause. However, when vertigo persists even after addressing the cause, we administer vestibular rehabilitation. This is a series of head and neck exercises that help you regain your balance. They acclimatize your body to move. Vertigo patients are so scared of falling that they become stiff. These exercises loosen them up. But should be done step-by-step. If you’re unwell and can’t get up from bed, then do a few exercises, whilst lying down. Move your body and head from one side to another and rotate your eyes. If you can sit, go from sitting to sleeping position a couple of times and move your arms and legs. When you can stand up, start walking, progress to jumping or walk around a small stool to stabilize yourself. And once you’re relatively active, I recommend you play badminton, table tennis.

Does the treatment call for surgery?

Surgery is usually reserved for extreme cases. They’re done to remove tumours, fluid or excessive wax. It is also done to repair the perforation of the eardrum.

What should one do in case of a vertigo attack? 

Firstly, please don’t panic. Sit down, don’t make abrupt movements and call for help. If you’re sleeping or sitting when you get the attack, don’t stand up suddenly. Your movements should be slow and deliberate.

What precautions should every vertigo patient take?

During treatment, a patient should be careful while crossing the road. Looking left and right can trigger vertigo. Someone should be with you. Avoid riding a bike. Riding requires an added sense of balance and if you have a vertigo attack while riding, it can cause serious injury. Avoid looking downwards from a height and use assistance while climbing down a flight of stairs.

What is the one message you would like to leave with vertigo patients who are reading this? 

A doctor I used to work with, insisted that once a serious disease was excluded, a patient should resume a normal life as soon as possible. And I couldn’t agree more. Just avoid activities that could put you and other people in danger. But don’t restrict yourself. Don’t stop going to work. If you do so, your recovery could take longer.

(This Article is Sponsored by Abbott)






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