 Good morning everyone. I am Dr. T.V. Jayantheshastri. I am an ENT head and ex surgeon. I am attached to Manipal Hospital, Maleshwaram. Today I would like to speak to you about vertigo. Vertigo means in a common term it is giddiness. But all giddiness need not be, all giddiness need not be vertigo and but vertigo is many a times giddiness. So I would like to briefly tell you what it means, what giddiness means, what vertigo means and how we can tackle it. So parts of the body that actually maintain our balance are brain, vestibular system, eyes and spinal cord. So in the brain there are parts like cerebellum, cerebrum and brainstem which are mainly responsible for maintaining the balance and vestibular system is there in the ear and our eyes helps us to maintain this one to look into where we are, what we are doing and all that and our spinal cord helps us to feel our sitting, standing and other positions. So how does actually this, all these systems work together? There is a sensory input from the atmosphere to us like in which space we are standing and whether we are standing crookedly or whether we are standing straight, whether we are bending a knee, all these things are this spatial and whether there is any rotation in movement or whether there is any linear movement all these things are absorbed and by the vestibular system. And our eyes tells us, since we can see our eyes tells us whether we are at a height or whether we are in the ground or whatever. So we can see it and we can of course the eyes collects all this information and our proprioceptive touch means, proprioceptive touch means whatever is in the spinal cord. Our spinal cord there are two columns which actually helps us to understand whether our feet is touching the ground or whether our hip is touching the ground or where we are standing, whether our shoulder is touching the wall, all this is absorbed by the proprioceptive sensations. This input is then carried to the brain and in the brain the cerebellum is the one where it coordinates and regulates the posture and movement and balance. The cerebrum is actually for the higher functions and that is level of thinking, memory and all those things cerebrum is for the higher functions. And when all this input comes to the brainstem, the brainstem gives out the it integrates the and it gives out the this one to the motor system. That means, what you should do whether you should stand straight, are you crooked if you should stand straight, whether there is a rotatory movement, are you supposed to hold on to something all that is and how your eye moves and all that is the motor system. Vestibular ocular reflex we call it with suppose there is a rotation movement and when the eyes are when the body is turning like that the eyes turn corrects itself back that is a vestibular ocular reflex. So, like it is just like how you see a train passing, you actually you keep looking like that as the train is passing. So, that is called that is the vestibular ocular reflex. So, these help in controlling the eye movements and also the body postures. Finally, the balance is achieved. So, in this picture you can see that there are some three semicircular canals in the year. So, there are three semicircular canals in both the years. So, these are the main apparatus to maintain balance in our body. So, in the semicircular canals in the next picture you can see that at the end there is a swelling, there is a bulging. These ends are called the ampoula and these ampoula help in giving us the sensation of rotation. They actually tell us that you are moving in this direction. So, and there are there is a thing called eutrical and saccule, you can see it is mentioned there eutrical and saccule. These are the ones that help us understand the linear movement like you are moving in the train in a linear way. So, that is these are the ones that help us understand the linear movement. So, it is actually a complex, the whole thing is a very complex procedure, but it happens just in seconds when actually you can you are in the you are in this position, you can immediately understand that you are in this position. See how quickly the brain works, how the how our body reflexes work. So, and the balance is maintained so quickly actually. So, what happens when there is derangement in these things? So, at that time there is a thing called vestibular spinal reflex where you will start the sensation of the body is being whether the sensation being is hurled or pulled that kind of sensation is felt when there is a derangement in this. And what happens our eye starts moving wherever it is hurled and pulled eye starts moving a little to correct that this one. At that time what happens there will be something called eye movement called as nystagmus. And then it goes on to the limbic system in the brain the whole thing there is a derangement there is a there will be a news to the limbic system that there is a derangement somewhere. And the limbic system will start developing some vomiting sensation due to the sympathetic stimulation. So, when a person comes to us so the diagnosis is mainly based on history, history history history that is a very important thing in these cases. And what are we but first when the patient comes what are we first ruling out? We have to rule out all the important things like any problem with the cardiovascular system or any problem with the nervous system all this we have to rule out. So, what we are going to ask them is there any shortness of breath is there any chest pain is there any symptoms of panic attacks because sometimes even panic attacks can cause a kind of giddiness. The patient feels giddy and is there any new medications that the patient has started or if already the patient is on medication has there been any alterations in the medications that that the patient was taking. So, all this actually is a very important thing to rule out all other problems to come to a conclusion that it is nothing but spinal vestibular spinal problem. So, we have to check all the vital signs like whether there is any hypertension that is high BP or hypotension is there any low BP or bradycardia. Bradycardia means is there any reduction in the heart rate. So, all these things point out a different thing like a cardiac problem. So, we have to check all this also we have to do ECG and blood glucose and serum electrolytes as a basic test because sometimes serum electrolytes like sodium for example, sodium if it reduces in the body then also there can be a feeling of giddiness and tiredness and so even minute reduction normally is 136 if it reduces to 130, 129 then the patient starts feeling little this one. So, that is very important thing which can also be corrected very easily. So, all these things we have to rule out before we say yes it is due to the ear. So, what is the history we take due to the ear and what do we say? So, first of all we ask the patient to describe the symptoms. What is it? Whether it is a rotatory vertigo or whether it is just an unsteadiness or what happens when he does it happen when it gets up from the bed or when he lies down in the night or when he lies down and turns to one side we have to ask all this history and whether it is persistent whether it is there throughout the day or is it there in between or at any particular intervals or is it in between intervals is it completely gone is the patient symptom free in between intervals all this is very important to us and is there any associated symptoms like nausea, anxiety or any neurological problems headache. Headache is very important a history for to rule out because migraine is one of the causes for giddiness also. So, initially the patient might have only headaches then he may develop headache with my with giddiness then later on it headache may completely disappear and there may be only headache only giddiness. So, what this particular entity we call as vestibular migraine which is actually very common because it is introduced induced due to stress and things like that which is very common. So, that we have to rule out. So, we ask a very important history is asking about headache. So, any other ear symptoms like ear discharge or decreased hearing or a ringing sensation in the ear is all very important to us after asking about the ear then turn to the eyes whether there is any blurring of the vision whether in double vision all that if there is double vision and things like that directly it points to the brain there is a problem with the brain probably. So, any other neurological symptoms like for example, in Parkinson's disease what happens as a patient is walking towards the target he suddenly starts walking too fast or when he is trying to he or she is trying to drink something there will be a spillage of water all this all this history we have to take. And any other risk factors like for example, if the has the patient has had a head injury or are there any or there are or there are any ototoxic drugs. Ototoxic drugs means drugs which are actually toxic to the ear. So, what happens in sometimes these drugs cannot be avoided due to various other important reasons and these drugs actually start cause a making the ear nerves weaker. So, there can be a hearing loss there can be some giddiness and things like that. So, we have to take a history of the drugs and then whereas, there is any spondylosis even the neck spondylosis also can cause kinking of the blood supply to the brain and leads on to giddiness. And is there any viplash injury? Viplash injury is when a person for example, is travelling in a car very fast and there is sudden breaks are applied that times what happens the body comes to an inertia, but the brain inside moves to to and fro inside the skull and gets injured. So, any such episodes are there. So, all this is important to arrive at a diagnosis. And as the patient is walking into our clinic we see how the patient is walking in. It is important to notice observe how he is walking in. Some patients with as I said positional vertigo they look at the floor and walk. So, that they do not trip and fall. So, this is observation is very important and bedside examinations we do in all the patients with vertigo careful blood side examination is important. As I said we have to look at the eyes, ears, cardiovascular system, neurological system as well as the ear, nevestibular system. There are certain tests for the vestibular system which should be done I will tell you later. And importantly we have to differentiate between the central vertigo and the peripheral vertigo. Central vertigo means it that which is arising from the brain and peripheral vertigo means that which is arising from the ears or sometimes from the vestibular spinal cord. So, central vertigo actually it is very important. There are certain differentiating points between the two, but many a times it can be overlapping. And once we know it is a central vertigo we have to do other examinations like MRI and things like that. So, that we do not miss any tumors what white central vertigo occurs. There are certain tumors in the brain that can cause. There can be a tuberculosis of the tubercular this one of the brain that can cause. And cystic circuses means there are certain worms that make their way into the this one that lay eggs and the eggs make their way into the brain and can lay and station themselves in certain areas which leads to this kind of a giddiness or something central vertigo whatever. So, all these things have to be ruled out. Hence it is very important for us to rule out whether it is a central vertigo or a peripheral vertigo. So, then how the patient presents to us either with a rotational vertigo means either the whole building is spinning or he himself is spinning. So, this we call as an acute vestibular disorder. This can happen even with a simple viral infection. Any common cold or even the recently what we had a coronavirus with all these viral infections a simple acute vertigo can occur. So, the other vertigo the type of vertigo is a positional vertigo that is when the patient gets up from the bed or lies down on the bed when he sits up or sits down or stands up or sometimes lying on the bed when they turn their head to the right or the left this is called a positional vertigo. And there can be vertigo unsteadyness without actual proper vertigo that means as the patient will have an unsteady gait. This can happen in when both the vestibular systems means from both the years the signals have become very weak then there can just be an unsteadyness there need not be a regular vertigo ok. So, and this can this kind of unsteadyness can happen in some cerebellar problems also as well as some neuromuscular problems also. And there can be some non-specific gaitness like precincope for example, person sees blood and he cannot take it. So, he is feeling giddy and if he falls down that is called something the precincope type that is called syncope actually falling is called syncope the precincope time he can have a gaitness that is also possible that is called non-specific gaitness and some times in psychogenic patients because of the this one the anxiety the panic attack and other things there can be some amount of the giddiness sometimes they can feel giddiness also in order to gain attention or something like that. So, what is actually so this is about the giddiness and what are the complications or consequences of this giddiness the patient has fear to move around by themselves. And they lose that confidence in the daily activities suddenly the patient can fall and there can be fractures or dislocations and things like that. And there can be road traffic accident also suppose a person is driving and he turns left or right to look at something then suddenly he can have giddiness and we cannot have the judging capacity and he can have a traffic accident. Also a person who is crossing the road also looking that side and this side and carefully crossing also can develop sudden giddiness and have some road traffic accidents. And there can be fire accidents in the kitchen because the lady who is lady or male who is working in the kitchen will have to bend get up and things like that during those times if they develop sudden giddiness they can fall on the stove or they can there can be some accidents like that. And finally what happens to these patients they become kind of dependent though not fully physically dependent also they become mentally dependent and they lose so much of confidence. So, it is very important that a patient with vertigo talks to us as early as possible and so that we can solve this problem at the bud itself instead of it allowing it to becoming become more and more. So, what this is all about vertigo when you come to us what we can do for this that I am going to explain to you in the next video. So, please stay with us for the next video. Thank you for joining me in this FB live session. If you like this video kindly share it with your family members and friends so that they can be also benefited by this. And if anybody has such kind of symptoms they can contact us so that we will be able to help them. So, meet you all in my next session. Thank you.