It was four months back that S. Sivan, 40, was struck by vertigo. Recalling the sequence of events he says, “Sometimes I felt as though the ground was tilting to a side as I’d walk. Then, one day, when I woke up and looked at the alarm clock, my head started spinning. When I tried to get up, I fell off the bed. Later, I felt fine and went to work. But during the day, I felt little twinges.” His condition worsened while returning home and he felt he’d collapse as he took the stairs to his fourth floor flat in one of Calcutta’s highrises. But Sivan attributed this bout of dizziness to his high blood pressure.

Biswarup Mukherjee, ENT surgeon, Advanced Medicare and Research Institute points out, “Patients of vertigo often tend to ignore the early symptoms of vertigo as a manifestation of their fluctuating blood pressure levels.” That was the mistake Sivan made. Four months later, an ENG (electro-nystagmography) and a couple of tests confirmed that Sivan has vertigo.

Vertigo is a symptom, not a disease. Any one of us could go down with vertigo, after a bout of flu, a severe ear infection or, in more serious cases, after a stroke or a tumour. But not very many people have a clear idea of vertigo. Abhijit Chatterjee, neurologist, Belle Vue, says, “Of the patients who complain of vertigo, 25 per cent are actually vertigo patients, while the remaining 75 per cent are simple cases of dizziness.”

There’s another misconception among patients. “Cervical spondylitis doesn’t cause vertigo,” stresses Arabinda Mukherjee, professor of neurology, Woodlands Nursing Home.

Symptoms of vertigo include an unsteady sensation when walking, rotary sensations, a sensation of being afloat in air and the feeling of a hollow space in the head. Some autonomic symptoms such as sweating, nausea and vomiting are often found to accompany vertigo attacks. Another symptom is nystagmus, in which the eyes move about involuntarily. These symptoms and sensations can occur at random and last temporarily, or they can be persistent and last permanently.

Mukherjee says, “We use tests like audiometry, ENG and sometimes a CT scan to determine if a patient has vertigo. Once that is determined, there are exercises that have proven to be helpful in curing vertigo, along with medicines.” Some of these are adaptation exercises such as Cawthorne, Epley’s and Brandt-Daroff (see box). So if there is a problem with the left ear, exercises are suggested for the right ear so that a strong right ear compensates for the weakness in the left ear.

Patients of vertigo should avoid high altitudes. For example, they should avoid staying in highrises, undertake activities that involve going up, such as climbing hills, trekking, looking out of speeding vehicles — essentially anything that aggravates the sensation of motion. Moreover, it is important to opt for a low salt diet.

Generally a normal salt diet includes 1,100-3,300 mg of salt a day while a low salt diet includes 400-1,000 mg of salt a day. “But a low salt diet is not helpful for a patient who has vertigo as a result of brain tumour,” cautions Asis Bhattacharyya, consultant neuro-surgeon, Peerless Hospital, adding, “So all restrictions are case specific.”

Plenty of fluids and fruit juices are also advisable for vertigoes patients. Such patients must avoid spicy food which leads to acidity and anything cold which could lead to ear infections.

So the next time you have a spell of dizziness, make sure you find out whether it is just a bout of dizziness or vertigo.

Checks and Balances

Exercises that can help maintain your inner ear function and balance:

Brandt-Daroff:

Sit on the edge of a bed and now lean to the side that causes the most vertigo. So now you would be lying on your side with your ear down. Remain in this position until either the vertigo goes away or 30 seconds have passed.

Sit up. If this causes vertigo, wait for it to stop. Repeat the procedure on the other side. Patients are usually instructed to do 20 repetitions of this exercise at least twice a day.

Epley’s manoeuvres:

Sit upright. Turn the head towards the affected side (say the left). With the head still turned, recline past the horizontal. Hold for 30 seconds in the reclined position. Now turn the head to the right and hold for 30 seconds. Now roll on to your right side. With the head still turned to the right (you are now looking towards the floor), hold for 30 seconds.

Sit upright and look over your right shoulder. Remain in this position for 30 seconds. Turn your head to the midline with the neck flexed, chin down through 45 degrees. Hold for 30 seconds.

Cawthorne Exercises:

(In bed or sitting)

Eye movements: Must be slow first, then quick — up and down, from side to side focusing on the index finger moving from three feet to one foot away from the face.

Head movements: Slow first, then quick, later with eyes shut, bending forward and backward, turning from side to side.

lLast but not least, prepare a list that indicates the date, the time you spent exercising, how often your eyes were open or closed, and how you felt during each exercise. But it’s best to consult a doctor before trying these exercises as they can be case specific.