The Vertigo Unit of the Hospital Costa del Sol treats around 850 patients annually in a specific consultation carried out by the center’s Otorhinolaryngology (ENT) area, whose objective is the diagnosis and treatment of vertigo and balance disorders. This takes place two days a week (Monday and Wednesday) from 3:00 p.m. to 8:00 p.m. and is attended by a team made up of a specialist in Otorhinolaryngology, in this case, the head of the service, Manuel Oliva; an audiometrist, audiologist and speech therapist, Rafael Casanova; and a nursing assistant.
These are complex patients since the cause can be difficult to diagnose, taking into account the variability of pathologies that, in addition to ear problems, can cause these limiting symptoms that greatly affect people’s quality of life. For Manuel Oliva, this complexity comes supervening because “a patient with vertigo has difficulty describing its symptoms and, sometimes, vertigo is embedded within a spectrum of other pathologies. In this sense, he points out, “in order to carry out an in-depth interrogation, anamnesis, physical examination, etc., it is essential to have enough time and ample spaces where they can introduce stretchers and carry out tests, since some have problems walking because they become destabilized and They can fall off.” “Apart from this way of working in the consultation, quality and warmth are offered in the care that patients greatly appreciate,” he highlights.
Between 20 and 30 percent of primary care consultations are usually related to vertigo, dizziness or balance disorders. In general, vertigo is more frequent in women than in men, in a ratio of 60/30, respectively.
The causes that can cause vertigo are many and varied. In this consultation, professionals focus mainly on those related to the ear: the back of the inner ear, the vestibule, acts as a movement and position sensor, a kind of ‘artificial horizon’ that informs the Nervous System Central on the position of the head and its movements.
In this sense, the most frequent processes are benign paroxysmal positional vertigo (frequent disorder that causes brief episodes of vertigo -false sensation of movement or rotation- in response to changes in the position of the head, which stimulate the posterior semicircular canal of the inner ear), Menière’s disease (inner ear disorder that causes episodes of dizziness and hearing loss) and vestibular neuritis (involvement of the vestibular nerve considered one of the main causes of vestibular syndrome with acute vertigo). However, there are also other diseases such as vestibular migraine, certain dysfunctions of the temporomandibular joint, drug side effects, infarcts or cerebral ischemia, brain tumors, kidney failure, malformations of the occipito-atloidal joint, functional alterations of pressure arterial, etc. that have little or nothing to do with ear problems and that can cause vertigo/dizziness/balance disorders. Sometimes, the patient already accesses this consultation diagnosed by their corresponding specialist, but it is important to ensure that there is no added otological problem.
On the other hand, psychological problems (psychogenic vertigo and Persistent Postural-Perceptual Dizziness or PPPD) also constitute a very important group of patients. Sometimes the patient’s psychology is what causes the symptoms, leading to their magnification, due to stress, or some other cause. However, in most cases there is a real underlying pathology, although the psychological conditions of the patient can camouflage, mix the symptoms or even distort and complicate the diagnosis. Cervical vertigo also occurs although, in the opinion of Manuel Oliva, “they are discussed. The current trend indicates that alternative causes to cervical ones must always be sought.
Vertigo-related problems represent a very important decrease in the quality of life of those who suffer from them. Its affectation can range from vertigo so you can have a moderate crisis of about 30 minutes, a few times a month; even those patients who may have an internal, disabling crisis, lasting hours and several times a week. In the words of this head of service: “Fortunately, the latter are the least frequent, but they can destroy the patient’s life. Day in and day out he has a crisis in which he falls to the ground, cannot move and vomits non-stop. A situation like this has important repercussions for the patient’s work and social life”. In that sense, he adds, “many of them also have their hearing affected, they progressively lose it in one or both ears and are accompanied by tinnitus, a continuous intense beeping sound that there is no way to eliminate. Sometimes it is controlled with headphones and sometimes it is not. Hearing problems also have a great influence on the patient’s relationships with the rest of his environment”.
In general, for this expert, the best way to avoid and improve this type of pathology is “like everything in health, “lead a healthy life, Mediterranean diet, regular exercise, avoid stress,…. In cases of vestibular migraine it is also recommended to avoid some foods rich in tyramine (chocolate, cured cheeses, shellfish…) alcohol, food additives, caffeine,… which could precipitate crises”.
Some of these pathologies have different levels of severity that have been studied using scientific methods that analyze qualitative data. For example, with Melière’s disease, the American Academy of ENT developed a scale at the functional level of the disease based on a questionnaire that stages the degree of functional involvement of Menière’s disease in the daily life of the patient from level 1 (the disease does not affect me at all) up to level 6 (I have been off work for more than 1 year due to this disease). Likewise, this same disease is also staged in stage I-IV according to the hearing level and in grades (AD) according to the response to treatment. This and other questionnaires such as the Dizziness Handicap Index are also available in this clinic at Hospital Costa del Sol to numerically assess the impact of vertigo/balance disorder in general on the patient’s life. In addition, there are other questionnaires based on quality of life, ability to do certain exercises, ability to stand up in certain situations, etc.
Treatments offered in this consultation
In this consultation, all kinds of treatments are offered, ranging from information and advice when it comes to banal and sporadic pathology. In these cases, it is only necessary to adequately inform the patient because their problem is not serious and offer possible diagnostic/therapeutic alternatives, on how to deal with the disease, if it is worth doing more tests, etc. Drug treatment is also offered since there is a great variety of them depending on the diagnosis, although, sometimes, it is only necessary to adjust the dose or replace/eliminate some that are causing side effects.
Physical and rehabilitative treatments are also offered. One of the most common causes of vertigo is Benign Paroxysmal Positional Vertigo. Its treatment consists of making some maneuvers in the consultation, moving the patient in a certain way on a stretcher to mobilize some particles lodged in one of the semicircular canals. According to Manuel Oliva, “it is surprising, because in the most favorable cases, the patient can leave the consultation completely cured. On other occasions, it is necessary to teach the patient to correctly use his balance system, or what is left of him, in order to lead as normal a life as possible”. For this treatment, this consultation has the help of the Rehabilitation service and the balance re-education protocols.
Another treatment option is vertigo surgery, which is carried out when the cause lies in one of the ears and cannot be controlled with conservative measures. In these cases, surgery is used to destroy the malfunctioning ear. Since a sensory organ is lost, it has to be complemented by subsequent balance rehabilitation.
Finally, psychotherapy is also a first-order treatment. In some cases, the patient has a significant underlying psychiatric pathology. In the words of Dr. Oliva, “in some cases we have detected attempted suicide in the consultation that had not been manifested with other specialists and, therefore, the participation of a psychiatrist and/or psychologist is needed.”