Understanding
Dizziness and Vertigo
“You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.”
- Julian Seifter -
Describing dizziness can be surprisingly difficult. Many people struggle to put into words what they feel and the term dizziness can mean very different things to different people. During your consultation, you will have the time and space to explain your symptoms in your own words.
What Do We Mean by Dizziness and Vertigo?
Many people use dizziness as a general term. In medical language, it often refers to sensations such as light-headedness, faintness, mental fog, or unsteadiness. Some people describe it as feeling like they are walking on a boat or as though they have had one glass of wine too many.
Vertigo, in contrast, involves a distinct spinning or whirling sensation in which you feel that you or your surroundings are moving when they are not. Both dizziness and vertigo can lead to imbalance, unsteadiness, or a sense of spatial disorientation.
Common Experiences and Their Causes
By looking at your specific symptoms, we can usually begin to identify which form of dizziness or imbalance you are experiencing. You may find that your story sounds like one of the following examples:
"I feel a violent spinning sensation for just a few seconds when I roll over in bed or look up at a high shelf."
This is often the hallmark of Benign Paroxysmal Positional Vertigo (BPPV) or displaced ear crystals. Because the trigger is mechanical, we can often fix this quickly with specialised physical manoeuvres.
During an assessment for BPPV, I may look for Nystagmus, which is a specific type of involuntary eye jumping. When you have BPPV, the jumping sensation is simply a natural, brief reaction to crystals shifting in the inner ear. Most often, it settles within seconds, but it can occasionally last up to a minute.
Even though these seconds may feel like an eternity when you are in the middle of a dizzy spell, please remember: it is a distressing feeling, but it is not dangerous in itself. If you feel vertigo coming on, simply remember to sit down to avoid losing your balance.
"Suddenly, the world started spinning and did not stop. I have been nauseous and off balance for days."
This is often caused by Vestibular Neuritis, which is a viral inflammation of the inner ear nerve.
"I get dizzy spells that last hours or days. I might not always have a headache, but light and noise really bother me."
These attacks are frequently related to Vestibular Migraine or Ménière’s Disease.
"I do not have the spins anymore, but I feel like I am walking on a boat or a cloud. Being in a grocery store or looking at a computer screen makes it much worse."
This is the hallmark of Persistent Postural Perceptual Dizziness (PPPD). In this condition, the brain stays on high alert following a previous dizzy spell or a period of stress.
"I felt like my heart was pounding out of my chest and I could not breathe. It was terrifying and I felt like I was dying."
These intense physical sensations are often associated with Anxiety or Hyperventilation. Shallow breathing can change the chemistry in your blood, which triggers or worsens feelings of dizziness and lightheadedness.
"I get dizzy and feel like I might faint specifically when I stand up quickly or get up and start to walk."
This is known as Orthostatic Hypotension, which is a temporary drop in blood pressure when you change positions.
"I get dizzy around loud noise or when I blow my nose. I can even hear my own pulse or chewing louder than I should."
These specific symptoms can be signs of Superior Canal Dehiscence, a condition where there is a thinning of the bone in the inner ear.
Beyond the Description: Why Timing and Triggers Matter
To find the root cause of these experiences, we look at two important factors. While your personal description is our essential starting point, the behaviour of the dizziness, specifically the timing and the triggers, provides the objective evidence needed for a precise diagnosis.
The starting point for understanding your balance system is a close look at your unique experience. Whether it is a spinning sensation, a rocking feeling, or lightheadedness, your description provides insight into how the brain is processing a mismatch in information. However, to confirm the source of the problem, the focus must also turn to the logic behind those feelings.
The Timing
The assessment focuses on whether the sensation lasts for seconds, hours, or days. It is also crucial to determine if it is a single event or if it comes in waves.
The Triggers
Identifying triggers involves determining if the dizziness happens only when moving your head or standing up, or if it starts spontaneously while sitting still. In some cases, the dizziness may be linked to certain environments.
By combining your personal story with these objective patterns of timing and triggers, the precise source of the problem can be identified. This dual approach ensures that treatment goes beyond simply addressing the feeling of dizziness, moving straight to the correct physical treatment for the underlying cause.
Peripheral vs. Central: Where does the issue start?
To understand these experiences, we look at where the mismatch is happening in your body. Vestibular disorders are broadly divided into peripheral and central causes. The peripheral vestibular system includes the labyrinth, nerves, and pathways from the inner ear to the brainstem, while the central system comprises the brain and the brainstem.
Peripheral Vestibular Disorders
Peripheral disorders originate within the inner ear. At the core of these conditions is a disruption in the vestibular apparatus, the fluid filled canals and sensors responsible for detecting head movement and gravitational pull.
When one of these disorders is present, the affected ear sends faulty motion data to the brain. Because this conflicts with the normal data sent by the healthy ear, the brain becomes confused by the mismatch, resulting in spinning (vertigo), nausea, or general unsteadiness.
While the symptoms can be intense and often feel alarming, peripheral disorders are generally benign in a medical sense. This means that while they are certainly life disrupting, they are typically not life threatening. These issues are often mechanical (like the displaced crystals in BPPV) or inflammatory (like a viral infection in Vestibular Neuritis).
Central Vestibular Disorders
While many balance problems start in the inner ear, central disorders start within the brain itself. You can think of your brain as a sophisticated computer that organises information from your eyes, your body, and your ears to keep you steady. In these conditions, the brain has trouble processing those signals correctly. This usually happens in the brainstem, which acts as the primary information gateway for your balance. Just like a busy entrance, it filters and passes along every signal your body sends to ensure your brain stays in constant communication with your environment.
When we look for the cause of these issues, we generally find they fall into two distinct groups:
The First Group: Physical Changes to the Structure
This group involves the physical hardware of your system. It includes conditions like a Stroke or a Transient Ischemic Attack (TIA), which is often called a mini stroke and occurs when blood flow to the balance centers is briefly interrupted. It also includes conditions like Multiple Sclerosis (MS), which can slow down the electrical signals traveling through your nerves.
We also look for physical growths such as an Acoustic Neuroma. While this growth technically starts on the balance nerve outside the brain, it sits in a very tight space. As it grows, it can begin to press against that primary information gateway in the brain, affecting both your balance and your hearing.
Because this group involves the physical structure of the brain and its connecting nerves, it is very important to have a medical screening with an ENT or neurologist to rule them out early on.
When to Seek Immediate Help (The 5 D's and 3 N's)
While most dizziness is not a medical emergency, it is important to know when symptoms might indicate a "central" issue that requires urgent care. If your dizziness is accompanied by any of these "Red Flags," please seek medical attention immediately:
The 5 D's:
Double Vision: Seeing two of everything or having blurry vision.
Drop Attacks: Sudden falls where you collapse to the floor while remaining conscious.
Dysarthria: Difficulty speaking or slurring your words.
Dysphagia: Difficulty swallowing.
Dizziness: Specifically when it is sudden, severe, and accompanied by other symptoms on this list.
The 3 N's:
Nausea: Severe or uncontrollable vomiting.
Numbness: Feeling "pins and needles" or a loss of sensation in your face, arms, or legs.
Nystagmus: Involuntary "dancing" or jerking of the eyes.
How it differs from BPPV: In an emergency situation, this eye jumping often happens while you are sitting perfectly still or looking straight ahead. Unlike BPPV, it does not go away after a few seconds and may change direction depending on where you look.
The Second Group: Functional Processing Errors
In this group, the physical structure of the brain looks perfectly healthy on an MRI, but the internal software is not running correctly. The two most common examples are Vestibular Migraine (VM) and Persistent Postural Perceptual Dizziness (PPPD).
In a Vestibular Migraine, the brain becomes hypersensitive to sensory input, essentially misinterpreting normal balance signals as a sense of spinning or rocking. With Persistent Postural Perceptual Dizziness, the brain remains in a state of high alert long after an initial injury has healed, leading to a chronic, daily sense of unsteadiness. Because these conditions involve the brain's internal processing rather than the ear itself, rehabilitation focuses on retuning how the brain interprets the world around it.
Other Factors
Dizziness can also be influenced by factors such as aging, autoimmune conditions, allergies, anxiety, and stress. An often overlooked cause is hyperventilation; this is a shallow breathing pattern commonly associated with anxiety that can trigger or worsen dizziness and vertigo.
What should I do if I suffer from dizziness?
If you experience dizziness or vertigo that does not resolve on its own, contact your general practitioner. They may refer you to an ENT specialist or send you directly to my practice.
An ENT specialist treats ear, nose, and throat conditions. In the French-speaking part of Switzerland, this specialist is known as an ORL (otorhinolaryngologist).
A Global Standard for Diagnosis:
The ICVD
While your personal description is the heart of our consultation, medical professionals worldwide use a standardised language to ensure accuracy in diagnosis and research. This framework is known as the International Classification of Vestibular Disorders (ICVD).
Established by the Bárány Society, these definitions provide a precise medical vocabulary that helps specialists differentiate between sensations that might feel similar but have very different origins. Understanding these formal categories ensures that you, your GP, and your specialist are all speaking the same language when discussing your symptoms.
On the right are the core definitions used globally to classify vestibular symptoms:
Dizziness is the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion. This includes sensations sometimes referred to as giddiness, lightheadedness, or non-specific dizziness, but does not include vertigo.
Presyncope (also near syncope or faintness) is the sensation of impending loss of consciousness. This sensation may or may not be followed by syncope. When patients report “lightheadedness,” it should be classified as presyncope, dizziness, or both.
Syncope (also faint) is transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope usually leads to loss of postural control and falling.
Vertigo is the sensation of self-motion (of head/body) when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement.
Unsteadiness is the feeling of being unstable while seated, standing, or walking without a particular directional preference. This sensation has previously been called disequilibrium or imbalance.
Classification of vestibular symptoms: Towards an international classification of vestibular disorders.Journal of Vestibular Research. 2009;19(1–2):1–13.