At any point of time, 1.3 per cent of Indians suffer from vertigo—an illusion of movement (mostly spinning) caused due to imbalance of the vestibular system—that leads to dizziness and loss of balance in patients, according to a study published recently in the Journal of The Association of Physicians of India.
However, despite the high prevalence rate, the study revealed that 52 per cent of vertigo patients said if they were warned not to drive, they wouldn't stop driving.
“In India, a majority of these patients are in their 50's. Our study mainly looks at attitude and knowledge about vertigo, other than the prevalence. The reason behind conducting this study is because one tenth of the population in various parts of the world go to the GP with a symptom of vertigo or due to an indirect effect of vertigo like a fall caused by dizziness,” says Mohan Kameshwaran, a senior ENT specialist from Chennai who heads the Madras ENT Research Foundation (MERF).
Around 1,167 patients were recruited from 37 centers from across the country in order to understand their knowledge, attitude and practice regarding vertigo. “When our forefathers adapted to a bipedal posture from a quadrupedal posture and became steady on two feet, it gave us certain evolutionary advantages. It freed our upper limbs to use tools for hunting and for dominating other species,” explains Kameshwaran.
“However, this evolutionary advantage came at a price—our balance became very precarious. You don't see vertigo in animals unless the symptom is created in them for experimental studies. For humans, it is a natural thing that happens at some point of time simply because our balance is still so precariously put and the slightest disturbance can cause vertigo,” he points out.
Experts say not only does vertigo reduce one's quality of life, but it also undermines a person's level of confidence as patients become highly disturbed psychologically, resulting in a feeling of insecurity.
The study further revealed that the most common cause of vertigo among Indians is benign paroxysmal positional vertigo (BPPV). Kameshwaran says BPPV is a fine disturbance in the inner ear where there is specialised cells with calcium, which gets fractured and starts floating around.
“This is followed by other causes like migraine, which is associated with a proportional number of patients and this is known as vestibular migraine, which is associated with lifestyle issues. Vestibular migraine is common in people who are high fliers or achievers who have highly stressful lives with disturbed sleep patterns and dieting habits. At least 10 per cent of migraine sufferers experience vertigo,” Kameshwaran adds.
After migraine, the third most common cause of vertigo is an inner ear infection called labyrinthitis. Doctors say the disturbance or infection of the inner ear is caused due to discharge or pain and becomes serious once it affects the brain. “The fourth most common cause of vertigo is Meniere's disease that also affects the inner ear. Around 20 per cent of these patients have vertigo, but the prevalence of the disease is still not known,” he says.
Despite the high prevalence of vertigo among patients in India, the nationwide study revealed that a total of 17.3 per cent of patients had low level of knowledge about this troublesome symptom. In fact, many believed vertigo is a genetic disorder, which experts say is far from the truth. While 73 per cent of the participants in the study had average knowledge about vertigo, only nine per cent of patients had a high level of knowledge that could enable them to find a cure.
Commenting on the findings of the study, Kameshwaran says there are specific sets of exercises that can help preventing attacks of vertigo. “ However, many patients do not perform these exercises. In Europe, a major episode of vertigo causes the driving license to be forfeited. On the other hand, Indians didn't know that with vertigo, you should not drive. This proves there are big deficiencies with our practices.”
The worrying factor is that 86 per cent of patients in India are hardly concerned about vertigo and only 10 per cent were extremely concerned about symptoms such as dizziness, nausea and poor balance.
Through this study, doctors say if vertigo is properly studied and the underlying cause is determined, it is highly treatable. “What has emerged from the study is that prescription doses to tackle this symptom are inadequate, so there is a need to educate our medical community about the need to give adequate dosage to patients. More than 80 per cent of Indian physicians do not give recommended doses for vertigo partly because a feeling among doctors is that Indian patients are different and hence, they don't want to adhere to western standards,” says Kameshwaran.
“Physicians forget we can't adjust doses according to our wishes and the drug has to be present at a certain level in the blood. If the blood level is not adequate, the drug won't do its job and it is no different from a placebo if not given in the right dosage,” he adds.
