Dizziness is one of the most common complaints in medicine and one of the most poorly investigated, because the word covers several completely different experiences.
Getting the description right narrows the diagnosis dramatically, and one of the most common causes has a treatment that works within minutes.
Four Different Things Called Dizziness
Describing which of these you experience is the most useful thing you can do in a consultation.
- Vertigo: a spinning sensation, either of yourself or the room. Suggests inner ear or, less commonly, brain
- Presyncope: lightheadedness, feeling about to faint, greying vision. Suggests a cardiac or blood pressure cause
- Disequilibrium: unsteadiness on the feet without spinning. Suggests neurological, joint or vision problems
- Non specific dizziness: a floating or foggy feeling, often associated with anxiety or hyperventilation
Genuine spinning points strongly toward the balance organs. Feeling faint on standing points toward blood pressure. These need different investigations entirely.
BPPV: Common and Curable
Benign paroxysmal positional vertigo is the most common cause of true vertigo, and it has a simple mechanical cure that many patients never receive.
Tiny calcium crystals normally sit in one part of the inner ear. When they dislodge into the semicircular canals, head movement makes them move, sending false signals of rotation.
- Brief intense spinning lasting seconds to under a minute
- Triggered by specific head positions: rolling over in bed, looking up, bending down
- Often first noticed on getting out of bed in the morning
- No hearing loss or tinnitus
- Nausea, and residual unsteadiness between attacks
Diagnosis is made by the Dix Hallpike test, and treatment is the Epley manoeuvre, a sequence of head positions that repositions the crystals. It resolves symptoms in a large majority, often in one or two sessions.
Vertigo medications do not treat BPPV and can prolong recovery. If you have positional vertigo lasting seconds, ask specifically about the Epley manoeuvre.
Vestibular Neuritis and Labyrinthitis
These follow viral infection and cause a very different pattern.
Sudden severe constant vertigo lasting days rather than seconds, with nausea, vomiting and difficulty walking. It is often severe enough that patients cannot stand.
Labyrinthitis includes hearing loss and tinnitus. Vestibular neuritis does not.
Treatment involves short term medication for nausea in the first days, then stopping it deliberately, because the brain needs to receive the abnormal signals to compensate. Prolonged use of vestibular suppressants delays recovery considerably.
Vestibular rehabilitation exercises accelerate compensation, and our physiotherapy department provides these.
Meniere Disease
Meniere disease causes a distinctive combination that makes it recognisable.
- Episodes of vertigo lasting twenty minutes to several hours
- Fluctuating hearing loss, typically low frequency at first
- Tinnitus, often described as a roaring
- A sensation of fullness or pressure in the ear
Episodes recur over years, and hearing loss can become permanent. Management includes salt restriction, diuretics, avoiding caffeine and alcohol, and treatments injected into the middle ear for resistant cases.
The duration is a key discriminator. Seconds suggests BPPV, minutes to hours suggests Meniere, days suggests vestibular neuritis.
The Causes That Are Not the Ear
Several important causes of dizziness have nothing to do with the balance organs.
- Postural hypotension: blood pressure dropping on standing, common with medications and dehydration
- Cardiac arrhythmia: dizziness with palpitations or fainting, needing cardiac assessment
- Anaemia, very common in Indian women
- Low blood sugar in people on diabetes treatment
- Medications: blood pressure drugs, sedatives and some antibiotics
- Anxiety and hyperventilation
- Vestibular migraine, which is under recognised and causes vertigo with or without headache
- Cervical spine problems
Postural hypotension is worth checking simply. Have your blood pressure measured lying down and again after standing for three minutes. A significant drop explains a great deal.
The Features That Suggest Something Serious
A small proportion of vertigo comes from the brain rather than the ear, and these features distinguish it.
- Double vision, or difficulty speaking or swallowing
- Weakness or numbness of the face or limbs
- Severe headache with vertigo, particularly of sudden onset
- Inability to walk at all, even with support
- Loss of consciousness
- Vertical rather than horizontal eye movements
- New vertigo in someone with significant vascular risk factors
The inability to walk unaided is particularly significant. Patients with inner ear vertigo are unsteady but can usually walk with assistance. Those who cannot stand at all need urgent assessment for stroke. Our neurology and stroke services assess these urgently.
What to Tell Your Doctor
These details narrow the diagnosis more than any test.
- Is it spinning, or feeling faint, or unsteadiness?
- How long does each episode last: seconds, minutes, hours or days?
- What brings it on, particularly specific head positions?
- Is there hearing loss, tinnitus or ear fullness?
- Are there headaches, or a history of migraine?
- What medications are you taking?
- Any neurological symptoms?
Keeping a short diary of episodes over a fortnight before your appointment is genuinely helpful, since the pattern is often clearer on paper than in memory.
Staying Safe Meanwhile
Practical measures reduce risk during ongoing symptoms.
- Move slowly when changing position, particularly getting out of bed
- Sit on the edge of the bed for a moment before standing
- Use night lighting, since vision helps compensate for balance problems
- Remove trip hazards and use bathroom grab rails
- Do not drive during active vertigo
- Stay hydrated, particularly in hot weather
- Avoid prolonged use of vestibular suppressant medication
Falls are the main danger, particularly in older adults where a fall can cause a fracture that changes independence permanently.
Describe your dizziness precisely and note how long episodes last, because that alone directs the diagnosis. Brief positional spinning is usually BPPV, which is curable in one visit with a repositioning manoeuvre rather than months of tablets.
Our ENT department at T. Nagar assesses vertigo, and Dr. Ulageswari sees balance referrals.
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