Time and again, Alfred Hitchcock’s Vertigo has been voted the best film ever made, yet very little is known about the balance disorder that causes symptoms of head spinning, dizziness, unsteadiness and wooziness.
It often strikes suddenly. Rishab Thakral, 36, was standing in a queue waiting to get off a cruise ship in Singapore on January 3 when he experienced his first dizzy spell. “My head started spinning and I almost fell. I initially thought it was because of the bobbing and swaying of the ship, but when it didn’t subside for a week, I went to a neurologist,” says the businessman from west Delhi.
Over the next few days, he underwent a battery of diagnostic tests, including neurological exams and an MRI for structural brain imaging. “All the results were normal, so I was referred to an ENT,” says Thakral, who was finally diagnosed with Mal de Debarquement Syndrome (MdDS), which causes imbalance after exposure to motion, usually after a sea cruise or flight. “You basically don’t get your land legs back,” is how Thakral describes it.
Treatment for vertigo depends on what’s causing it. Sometimes the symptoms go away without treatment after the brain compensates by relying on other mechanisms to regain some balance. But often, people need treatment to stand steady again.
“Dizziness and vertigo from an inner-ear or vestibular problem are common in adults over 65 and are a leading cause of falls. Prescriptive drugs and vestibular rehabilitation therapy [VRT] help some people,” says Dr Shalabh Sharma, a senior ear, nose and throat consultant surgeon at Delhi’s Sir Ganga Ram Hospital.
Customised VRT, popularly referred to as Cawthorne-Cooksey exercises, are more effective than generic ones. They help resolve vertigo symptoms triggered by conditions as benign paroxysmal positional vertigo (or BPPV), bilateral and unilateral dysfunctions, otolith dysfunction and vestibular labyrinthitis.
It helped Thakral control his dizziness, but it’s still not completely gone. “I’m okay 90 per cent of the time, and am due for a follow-up to find out if I can be weaned off the medicine,” he says.
For some, stress is the trigger. On April 18, Susheel Asopa, a technocrat-turned-politician who is now secretary of the Rajasthan Pradesh Congress Committee in Jaipur, suddenly felt so dizzy that he lost his balance and fell. “I lost my younger brother Ghanshyam to oral cancer on March 20 and had just returned to Jaipur after three weeks in our village for his last rites. I was home when my head started spinning so much that I had to lie down,” says Asopa, 56.
A general physician at a local clinic gave Asopa medicines for dizziness and nausea and sent him home. When the symptoms did not go away after three days, he visited a vertigo clinic run by ENT surgeon Dr Anita Bhandari. The clinic uses the NeuroEquilibrium platform to diagnose and treat vertigo, dizziness and imbalance and comes with a special rehabilitation and patient-monitoring module.
“I was diagnosed with BPPV and responded well to medicines and exercises,” said Asopa, who was prescribed a canalith repositioning procedure designed to move calcium deposits out of the ear canal into an inner ear chamber so they can be absorbed by the body.
Asopa is free of symptoms and not on any medication now.
On shaky ground
“Vertigo can only be healed by curing the disease that gave rise to it,” says Dr Prabodh Karnik, ENT consultant at Mumbai’s Nanavati hospital. For example, if the vertigo is caused by an infection or inflammation, antibodies or steroids reduce swelling and cure infection; and if Meniere’s disease is the cause, diuretics are prescribed to reduce pressure from fluid build-up.
Parveen Khan, a 62-year-old homemaker in Mumbai, had such severe vertigo two months ago that she couldn’t sleep at night. “The room felt like it was spinning even when I was lying down and that scared me a lot,” she says. “I was afraid to stand up.”
When the symptoms persisted over a week, she consulted a general physician, who explained that vertigo typically points to a range of diseases, including diabetes, thyroid imbalances, tinnitus, inner/outer/middle ear damage, and infectious diseases such as typhoid and tuberculosis. In rare cases, it can be a sign of brain tumours or multiple sclerosis.
In Khan’s case, it turned out to be connected to high thyroid levels. Once she began treatment to regulate her thyroid levels, the vertigo went away.
“Most people don’t realise that vertigo is a symptom and not a disease in itself,” says Dr Jayant Gandhi, ENT surgeon at Mumbai’s Nanavati hospital. “It is actually very closely tied to lifestyle diseases.”