DO you sometimes feel like the room is spinning? Has it happened before? If you are a senior citizen and you’ve had this sensation before, it is time to see your doctor.
Ear, nose and throat specialist Dr Asha Gupta explains that vertigo is a sensation of imbalance and most commonly it presents in a spinning sensation.
According to Dr Asha there are different types of vertigo:
Vertigo related to inner ear balance
The most common vertigo among the elderly is benign paroxysmal positional vertigo (BPPV). Inside the inner ear, there is a balance organ and inside the balance organ there are canals which have tiny stones or debris. This debris move in a certain direction when we change positions. If the debris get lodged in the wrong canal, it stimulates dizziness when a person turns in the direction that the canal is responsible for. It can be associated with nausea and vomiting as well. Even when senior citizens roll over in bed or get up from a lying down position, they may get the spinning sensation.
In Meniere’s disease there is a combination of dizziness, reduced hearing and also tinnitus, which is a sound in the ear. That happens because there is an increase buildup of fluid in the inner ear.
And of course there are vertigos which are of the brain origin. These need to be assessed by a neurologist. It could be a sign of stroke or something more sinister.
Dr Asha explains that while people of all ages can get vertigo, in the elderly it tends to be complicated.
“The elderly can get dizziness as a result of sudden drop or sudden increase of pressure because the pressure builds, because of the medications ….
“When we say balance it includes the input from the eyes, brain, ears and sensation of feet. In the elderly all of this can be affected in permutations of combinations. For example, if their vision is bad and their knees are already wobbly, then when they get vertigo it is worse than people who just have dizziness and no other factors. So, it’s very complex in the elderly.
“If they are diabetic and suddenly their blood sugar level drops, they can feel really dizzy. If their sugar level shoots up, they may also feel dizzy,” she says.
Therefore, when an elderly comes into the hospital complaining of vertigo, a lot of things need to be checked.
Firstly, the doctors would need to check if the reason is because of the ear or brain or the medications that the elderly is taking. They are advised to bring all their medications with them so the doctor can assess if the vertigo is medication-related.
“The doctor would see if it is peripheral or ear-related, are if there are other symptoms like tinnitus, reduced hearing, is it an acute attack or a chronic, long-standing problem? Based on that, they will direct where the patient should go.
“Normally, we need to first see what the cause. If it is just pure vertigo and otherwise the patient is well, we may need to do certain positional tests in the clinic itself, to see if it is position-related. So, there are certain tests we can do in the clinic such as putting them in different positions to see if it triggers off the vertigo.
“If it is just as simple as that, BPPV, then we will do manoeuvres to correct those debris into the correct canals and teach them some vestibular exercises. Then we give them medication to improve the circulation to the balance organs. That is the ENT part of it.
“But of course, if we suspect there is something else, whether there is a growth in the balance nerves or anywhere, then would ask for an MRI to be done.
“We would also need to do an MRI just to rule out stroke or anything else. And, of course, they would need to go for a blood test for the sugar,” says Dr Asha.
If the source of the vertigo is the inner ear, the elderly would have to do some vestibular exercises and also take some medication. Dr Asha says, generally doctors try to do more exercises and give less medication because most of the elderly are already taking a lot of medications.
The only issue with vestibular exercises is that it requires neck movements and this could be tricky if the elderly has cervical spondylosis because they would find it difficult to move their neck.
Dr Asha says if the source of the vertigo is the inner ear, the complications are not so much from the treatment as it is from the consequences of having vertigo, as the elderly would be prone to falls.
“Sometimes the vertigo could be recurring or just that singular time. So we have to warn patients that sometimes vertigo can come back. People who are elderly and have co-morbid conditions like poor vision or diabetic neuropathy, where they can’t feel sensations in their feet so much, are more prone to vertigo once they get it. They are even at higher risk of having accidents related to dizziness like falls or slips and fractures and head injuries.
“The medication may continue over a long term because in the elderly it takes longer to resolve the issue and we give them long term sometimes because the chance of recurrence is higher, so it is to prevent recurrence as well,” says Dr Asha.
The elderly may sometimes brush off vertigo as just another sign of ageing, while the family might think they just need rest. Instead of putting it off, the elderly should pay a visit to their doctor to confirm it is not vertigo or anything more serious.
“A lot of conditions can be treated if they come in early, especially the positional cases,” says Dr Asha.
She advises the elderly to see their regular physician if they have vertigo. The physician would then assess and refer them to a specialist.
However, if there is an acute attack of spinning sensation, headache, nausea, vomiting and blurring of vision, then it is advisable for the elderly to go directly to the hospital.
They should also bring along their medications and all their medical records.
Dr Asha warns that sometimes, if the elderly is having an acute attack, they would not be able to open their eyes and talk. It is best that their family members be with them to communicate with the doctor.
In the home, some precautions need to be taken as well. A person with vertigo or who has a history of vertigo should not be driving nor operating heavy machinery. They should already be on a regular followup with their physician if they have co-existing problems so that the doctor can monitor for any of the risk factors.
At home, there should be grab handles in the bathroom and anti-slip rugs with no slippery surfaces.
If they are still in the period of having dizziness and it’s not controlled yet, Dr Asha suggests avoiding the stairs as well.