Prof. Dr. Şenol Polat

Dizziness and Vertigo

How do we keep our balance?
Balance is actually one of our sense organs, although many people don’t know, and it is the oldest sense among the senses phylogenetically. Normal balance function provides the ability of the body to maintain its upright position (while stationary or on the move). For this to happen, precise and clear data should be obtained from the vestibular, visual and body sensory systems (proprioceptive system), these data should be associated with each other, unnecessary information should be eliminated and the selected ones should be linked to the appropriate action. In addition to a robust neurological system, muscular and skeletal systems are required for all this to happen. Failure of any of these systems causes imbalance and falls in the patient.

What is vertigo?
Vertigo means dizziness. Although vertigo is sometimes called a disease, it is often a collection of symptoms for us. It tells us a clinical picture. The person expresses that his head is spinning, those around him or himself. In general, ‘feeling of emptiness’, ‘being like a boiler’, ‘stupor’ are the descriptions used by patients.

Vertigo can be briefly described as ‘motion illusion’. The orientation of the patient is disturbed and / or the patient develops the impression that the surrounding items are mobile. Drowsiness, patient’s staggering, shaking, difficulty finding balance, and feeling drunk. In the elderly group, there may also be dizziness or balance disorders under unknown and unexpected falls.

Which department should treat the patient suffering from dizziness, in the hospital?
The biggest challenge for patients suffering from dizziness is finding the right department and doctor in the hospital. Studies show that patients who change departments and physicians most are those who suffer from dizziness. In some studies, it has been proven that a patient changes an average of 9 physicians to resolve the complaint of dizziness. There may be many reasons why patients change physicians, departments or centers in this way:

1. Dizziness is an ambiguous complaint, which can be difficult to describe and recognize.

2. Sometimes the underlying reason may not be found.

3. The disease that causes dizziness can be difficult and long to treat.

4. Some of the diseases that cause dizziness will repeat intermittently.

5. Knowing the causes of dizziness, getting to know and dealing with patients with dizziness require a deep knowledge and experience.

What could be the reasons under the dizziness complaint?
In patients with dizziness, a detailed history should be taken first. Because many diseases that can cause dizziness can be determined as a preliminary diagnosis even by taking only the patient’s history. For example, if dizziness occurs with changing position, and if it takes short time in horizontal positions especially and if there is no hearing disorders and no complaints at other times or only mild dizziness, this is probably ‘benign paroxysmal positional vertigo’. If the patient had a very severe dizziness, there was no complaint of nausea, vomiting, hearing, this suggests ‘acute vestibulopathy’. If there is a hearing loss as well as turning, the disease defined as ‘sudden hearing loss’ can be considered.

These examples and variations can be reproduced. To summarize, the physician should have a good knowledge and a very detailed story should be taken from the patient. The patient should rest patiently and provide an environment for the patient to explain what they are experiencing. The most common causes of dizziness may be benign paroxysmal positional vertigo (BPPV), Kr vestibulopathy, migrainous vestibulopathy (vestibular migraine), or endolymphatic hydrops (Meniere’s disease). These diseases can also coexist in the patient. In other words, while the patient is being followed up with BPPV diagnosis, Meniere’s disease or migraine symptoms may also develop during the disease process. To a significant extent, the intersection set of these diseases suggests that there are underlying common causes. For example, some psychiatric diseases, especially anxiety disorder, may occur in patients with dizziness, KR vestibulopathy, migrainous vestibulopathy and hydrops. The opposite can also happen, that is, psychiatric illnesses such as anxiety disorder may bring dizziness. The reasons for all this are investigated, but we do not have clear information yet. In some of our studies, it has been emphasized that there may be disruption in ‘autonomic nervous system’ functions. The work of some other centers focuses on virus infections. After taking the history of the patient, examination should be performed and if necessary, the suspected disease should be confirmed by vestibular (balance) tests. Then, treatment and rehabilitation, if necessary, are planned.

What are the points that patients should know especially about dizziness?
1. Dizziness is definitely not a psychological disease. It has an organic reason.

2. The best treatment for dizziness is through making the correct diagnosis. If there is misdiagnose, the treatment will be wrong and the complaints will worsen.

3. Again, correct treatment is very important. Compensation for improper treatment can be much more difficult.

4. It is very important to know the disease and its causes. Recognizing the disease will ensure not to be afraid of it.

5. A significant part of dizziness diseases can be treated, and the disease can easily be brought under control in a significant portion of the other small group of patients.

6. The patient should always be in contact with the doctor, not be afraid of the disease and dizziness.

7. There should be a physician who can listen to the patient patiently.

8. The center should be a place where necessary balance tests can be performed.

9. The physician must have the necessary knowledge and experience.


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