Vestibular Medicine in India

Vestibular Medicine is the science of the Balance system. The organs vital to maintain balance are collectively grouped as the Vestibular Organs, or simply the Vestibule.  Unlike the big organ systems like the CardioVascular System (CVS) or the Central Nervous System (CNS), the Vestibule is small, kind of works in the background without drawing too much attention to it and is relatively low key. Hence the Medical Councils all over the world did not find it worth their time to allocate a separate specialisation to the science of balance, so you rarely find a doctor who tells you he/she specialises in Balance or Vestibular System unlike a plethora of specialists in Cardiology and Neurology. This forms part of the problem we have.

Since there are multiple causes of vertigo (dizziness), and the Vestibule is closely related to the hearing organ or the cochlea, Vestibular medicine is in a way clubbed with ENT, though not at an advanced level. Thence, those ENT Doctors who have a generic interest in the balance system have taken a step forward and claimed Vestibule as their specialisation. Of course, since all nerves ultimately reach the Brain, and dizziness as a symptom can have its roots at the CNS the Neurologists too have a stake in the game.  But the significant problem here is that Vertigo is not THE DISEASE the ENT.S and Neurologists bargained for during their training as doctors.

The glamour of being an ENT Surgeon is right there in the name of the specialisation, that is Surgery. Most cases of Vertigo do not require surgery,  and so during the days of training, most of which are spent anticipating a stint in the Operation theatre, Vertigo as a disease is at the far end of the mind of the budding surgeon.  More often than not it continues to snooze there unless vigorously shaken up by the surgeon's conscience or, more frequently,  the Head of Department.

Likewise, the budding Neurologist is busy dealing with life threatening diseases such as Stroke, Brainstem disease or siezures. Vertigo therefore is left without being anyone's priority and by the time practicing doctors realise the sheer volume of the problem in their patients, its too late to go back to the text book so most patients would end up taking generic antivertigo medicines which have little effect at the root of the problem, or running around different set of ENTs and Neurologists who themselves would be busy dodging the patient elsewhere.

If Vertigo as a symptom needs to be managed rationally, it will need to be integrated early on in the medical curriculum. Most Undergraduate Medical Students spend immense time learning the intricacies of managing complex surgeries when more often than not the big chunk of patients they see will come with symptoms of  back pain and vertigo, and time spent on the latter two is little, if any at all.

The author, Dr Kshitij Malik is an Audiovestibular Physician, a Post Graduate from University College London and specilises in Hearing & Vertigo disorders. He can be connected at dr.kshitij@primehearing.com