"Vertigo is not the diagnosis; it is a symptom"

Vertigo

Ricardo Ceballos, lecturer during the Audiology Updating Conference of Asoaudio in Cali, Colombia

Vertigo is a very common symptom in human beings. “It can be defined as a sensation of movement of the person or the surroundings of the same person but without any such movement really existing. It is an illusion, a sign of a balance system disorder interpreted by the brain,” explained Dr. Ricardo Ceballos, neurotologist at The American British Cowdray-Medical and Neurological Center during the Asoaudio congress in Cali, Colombia, last February.

Vertigo is not the diagnosis; it is a symptom, and it indicates that something is going wrong in the brain or the ear, so one must discover what is causing the vertigo in order to determine if it is treatable or if it can be rehabilitated.

It is important to differentiate between vertigo and a dizzy spell. In the first, the patient believes he or she is turning round, and that is true vertigo. If, however, they feel disoriented without anything moving, that is dizziness. In other words, vertigo is a sensation of movement, while dizziness is a less-aggressive spatial disorientation.

Ceballos affirmed that vertigo is cured in certain types of diagnoses, controlled in some cases, and rehabilitated in others. “There are balance system disorders that can be cured, such as benign positional vertigo; others can be controlled, such as Meniere’s disease; others are rehabilitated, such as damage caused to the vestibular system by ototoxic drugs, among them gentamicin, an antibiotic that permanently and severely damages the inner ear receptors. In the latter case, there is no alternative to using vestibular rehabilitation, a fascinating treatment area for balance system issues, often based on cephalic or ocular exercise programmes designed to increase the speed with which the brain compensates for damage produced in the labyrinth,” pointed out the expert from Mexico.

Vertigo is diagnosed through directed clinical history, a physical examination in line with the suspected diagnosis and, occasionally, through tests set up to measure or trace the damage caused by the underlying disorder. Nevertheless, “diagnostic error in vestibular disorders is very frequent due to the lack of specific academic programmes during general medical training and that of related specialties. One of the more common motives is fear or lack of knowledge at clinics of vestibular and oculomotor physiology, as well as its application during diagnostic processes,” explained the expert, who pointed out that these errors do not only occur in Latin America but are common worldwide. Among diagnostic alternatives is, perhaps, anamnesis, or clinical history, this being the fundamental pillar of the overall algorithm. In itself, it is extremely sensitive to the detection of the topography and probably etiology of peripheral and central vestibular disorders and dysfunction. The problem with a clinical history approach is that few specialists can build the kind of complete document that really serves as the key tool for detecting vertigo. One of the big snags in this process is a doctor’s consultation time, insufficient for both the medic and the patient.

The best way to overcome this obstacle is to make professionals aware of prioritising clinical history as the principle responsibility to fulfil when dealing with patients with dizziness. It is a task that even affects state health systems where surgeries are so saturated on a daily basis that useful medical interviews cannot easily be carried out.

Summing up at the end of the day, the message put across was that “modern neuro-otology has reached such a level of sophistication that practically no patient with vertigo or dizziness lacks diagnostic and therapeutic options,” said Ricardo Ceballos.

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Photo: M.B.P.

Mara Brugés Polo, editor in chief of Audio Infos Latin America