HEALTHWATCH
Do you feel giddy?
DR. H. GANAPATHY
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Feel giddy? Don't panic. First think of the balance system, especially the inner ear.
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PHOTO: REUTERS
Spinning sensation: The problem could be due to inner ear disorders.
A 45-year-old obese individual reports to emergency room with a history of acute giddiness with vomiting, perspiration, and palpitation. Another 65-year-old with a similar history also has double vision and slurred speech. Yet another in the twenties has similar complaints along with ringing and a block in the ear.
It is not uncommon to find some young individuals with similar acute symptoms along with cold and fever preceding giddiness.
All of them irrespective of the age and the slight dissimilarity in history will undergo an emergency ECG and an MRI on the advice of a cardiologist and neurologist. Once the attending physician treats the condition, the giddiness settles down temporarily but recurs after some time in some cases.
Common symptom
What do these people have in common and why do they report to emergency? All of them would have thought that their symptoms meant a heart attack or a neurological disorder.
There is nothing wrong with this assumption. When the head reels most people assume that the symptom arises from a problem in the brain. Others fear a heart attack, as palpitation and sweating occur along with giddiness. Others associate movement of objects with an eye problem.
The most important symptom was giddiness. Other indications like nausea, vomiting and sweating were associated features. But it is these associated symptoms, rather than giddiness, that makes people panic.
Some individuals have recurrent giddiness either related to certain positions of the head and body or a constant feeling of imbalance. All of them have disorder of balance. If so which part of the body is affected? What is the cause of this disorder?
Vertigo
Giddiness (vertigo) means undergoing a sensation that either the person or the environment around is moving (usually spinning). This can be either a rotational or side-to-side (oscillating) movement. Only such sensation of movements is called true giddiness or vertigo.
Many people mistakenly describe other symptoms like heaviness, light-headedness, loss of consciousness, blurring of vision as giddiness though there is no sensation of movement. These are called non-vestibular symptoms. Moreover giddiness or vertigo is a symptom and not a disease as it is made out to be.
Giddiness develops when a sensitive structure in the inner ear — the crista or otolithic organ — is stimulated. Moving the fluid inside the semicircular canal can stimulate the crista. A simple example is the giddiness induced by a merry-go-round ride. The otoliths are stimulated by lack of gravity. Humans also lose balance due to ingestion of alcohol, which acts on the cerebellum of brain.
Alcohol also gets in and out of semicircular canal due to the difference in density between alcohol and the fluid in the semicircular canal. This results in giddiness.
Giddiness develops mostly due to inner ear disorders and less commonly due to disorders of brain. Hence it is imperative to locate the exact site of the origin of giddiness.
Treatment
A Neurotologist, who is an ENT surgeon who has specialised in this field, has to be consulted. A special instrument, Electronystagmography, is used to test the balance organ. Videonystagmography is a recent introduction in this field. Having located the site of lesion the individual is subjected to various tests.
Treatment of giddiness involves drug therapy in the acute stage. Symptomatic treatment is given to control giddiness and its associated features like vomiting and dehydration.
Once the acute stage is overcome, drugs are tapered or stopped. In certain cases a maintenance dose is advised. In any case drugs should never be taken for a very long period to control giddiness. All patients are taught vestibular rehabilitation exercise.
Certain conditions require diet control. In some cases drugs are injected into the middle ear to control giddiness.
There are cases of intractable vertigo or giddiness, which are subjected to either conservative or radical surgery of the inner ear.
Giddiness is mainly a symptom of inner ear disorder and less commonly of the brain. Since the manifestation of giddiness and its accompanying symptoms like nausea, vomiting, palpitation, sweating, purging, unsteady feeling are felt far away from the site of origin; people do not associate giddiness with the ear. Hence they knock at the doors of other specialties.
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The balancing act
Three systems or pillars — vestibular system, eyes, and touch and joint system — maintain balance or equilibrium.
The vestibular system starts in the inner ear and ends at cortex of brain.
The ear is divided into three parts — external, middle, and inner. The inner ear has two parts — the cochlea or the organ of hearing, and the balance organ consisting of three semicircular canals, utricle and saccule.
The nerve responsible for balance starts from here and ends in a centre called vestibular nuclei in the brain stem. From there, the balance organ is connected with eyes, brain, and limbs.
The writer is a neurotologist and E.N.T. surgeon based in Chennai.
E-mail: ganapathy_ent@dataone.in
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