Current Perspective: Vertigo in the Elderly

Special Article - Vertigo

Gerontol Geriatr Res. 2021; 7(1): 1049.

Current Perspective: Vertigo in the Elderly

Yeolekar AM¹* and Yeolekar ME²

¹Associate Professor, Department of ENT, Post-Graduate Institute and YCM Hospital, Pimpri, Pune, India

²Consultant Physician and Fmr. Professor & Head of Internal Medicine, K.J Somaiya Medical College and Hospital, Ayurvihar, Sion, Mumbai, India

*Corresponding author: Aditya M Yeolekar, Associate Professor, Department of ENT, Post-Graduate Institute and YCM Hospital, Pimpri, Pune-411018, India

Received: April 01, 2021; Accepted: April 19, 2021; Published: April 26, 2021

Abstract

Vertigo is a relatively complex condition demanding a skilfully collected and analyzed history. When an elderly patient presents with vertigo, some conditions are most commonly considered highly possible and likely whereas others (prevalent more in young) tend to be excluded from the mental algorithm of the clinician. It also matters to whom the patient presents first-internist, neurologist or the otolaryngologist. An important feature in vertigo in the elderly is the probability of it being multifactorial because of co-morbid conditions that could contribute to the complexity of manifestations. Conducting and appropriately interpreting the bedside tests/maneuvers and thereafter selecting battery of tests/investigations in a sequential manner can clinch the issue of a fair diagnosis in most cases. The Covid Dimension: Any discussion on vertigo would be incomplete without noting the findings on vertigo reported abundantly over the last one year. The compounding COVID angle merits being duly and appropriately considered.

Keywords: Vertigo; Elderly; Geriatrics; COVID0

Introduction

With an enhanced life span and longevity, a population feature, an increasing number of persons may approach a doctor through telemedicine, referral, and direct consultation for dizziness. Dizziness and balance disorders in the older adult should be considered multifactorial, and can be extremely difficult to diagnose [1]. This symptom might range from ‘acutely’ distressing to ‘tolerable’, mostly on some prior medication. Vertigo and dizziness are not synonymous with each other. True vertigo implies an equilibrium disturbance associated with the dysfunction of either central or peripheral vestibular system. Individuals with vertigo usually complain of pure sensation of rotation or spinning. Dizziness on the other hand includes pre-syncope, light headedness, disequilibrium, and other disorders due to cardiovascular, neurologic or metabolic illness and true vertigo. The prevalence of dizziness increases steadily with age; 30% of people older than 65 years’ experience dizziness in some form [2]. Further, older people with chronic dizziness or imbalance have two to three times propensity to fall in comparison with older people who do not experience these problems. The main causes of dizziness are divided into five main categories: a) Otologic (peripheral); b) Central; such as cerebrovascular stroke; c) Medical and toxic: Including low or high blood pressure, low blood sugar, infections and adverse effects of drugs and drug interactions; d) Psychogenic: hyperventilation associated with anxiety attacks and e) Unlocalized: The causes of peripheral vertigo mainly include Benign Paroxysmal Postural Vertigo, Meniere’s disease, Vestibular Neuronitis, Cholesteatoma-labyrinthine fistula, Acute labyrinthitis, Herpes Zoster Oticus, Perilymphatic fistula, Acoustic Neuroma and superior semicircular canal dehiscence. Central causes include Cerebellopontine angle tumor, Cerebrovascular stroke, Multiple Sclerosis and Migraine. Other causes are cervical vertigo, drug induced vertigo and psychogenic vertigo.

According to the duration of symptoms of vertigo, the probable causes can be predicted as in Table 1.

Citation: Yeolekar AM and Yeolekar ME. Current Perspective: Vertigo in the Elderly. Gerontol Geriatr Res. 2021; 7(1): 1049.