Explanation of common diagnoses in my domain of work.

Specialising in dizziness, balance, tinnitus, headache and more...

Dizziness and Vertigo

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. Together, we clarify what you are experiencing and determine the most likely cause.

How will I help you?

Every patient starts with a comprehensive intake consultation. I listen carefully to your story and ask targeted questions to better understand your symptoms. When needed, I perform specific clinical tests. Based on this assessment, we form a clear working hypothesis or diagnosis. Because dizziness can have many causes, treatment is always individual. Together, we develop a personalised treatment plan aimed at reducing or resolving your symptoms and helping you return to daily activities with confidence.

What Do We Mean by Dizziness and Vertigo?

Many people use dizziness as a general term. Medically, it often refers to sensations such as light‑headedness, faintness, brain fog, or unsteadiness. Some people describe it as walking on a boat or feeling as though they have had one glass of wine too many.

When there is a clear spinning or whirling sensation — where you feel that you or the world around you is moving when it is not — we speak of vertigo. Both dizziness and vertigo can lead to imbalance, unsteadiness, or spatial disorientation.

When Does Dizziness Occur?

Dizziness, vertigo, or a sense of disequilibrium can occur when one or more parts of this balance system are not functioning properly. This is referred to as a vestibular disorder.

Vestibular disorders are broadly divided into peripheral and central causes.

Peripheral Vestibular Disorders

Peripheral vestibular disorders originate in the inner ear. Common examples include:

Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Ménière’s disease
Secondary endolymphatic hydrops

One of the most common causes of vertigo is BPPV, which is explained in more detail below.

Central Vestibular Disorders

Central vestibular disorders originate in the brain and are less common. They involve changes in how the brain processes vestibular, visual, and postural information rather than a problem in the inner ear itself. These conditions affect the brainstem, cerebellum, or central vestibular networks.

Although vertigo may occur, people more commonly experience motion sensitivity, imbalance, coordination difficulties, or visual sensitivity. Other possible symptoms include difficulties with speech, vision, attention, memory, or a sensation of being pulled or pushed to one side.

Examples of central vestibular disorders include stroke or transient ischaemic attack (TIA) affecting the posterior circulation, multiple sclerosis, cerebellar disorders, vestibular migraine, and persistent postural‑perceptual dizziness (PPPD).

Persistent Postural‑Perceptual Dizziness (PPPD)

PPPD is a central, functional vestibular disorder. There is no structural damage to the brain or inner ear. Symptoms arise from altered central processing of balance and sensory information, often following an initial event such as BPPV, vestibular neuritis, migraine, concussion, or a period of acute dizziness or anxiety.

People with PPPD typically experience persistent non‑spinning dizziness or unsteadiness lasting more than three months. Symptoms are often worse when standing or walking, during movement, or in visually busy environments. Medical imaging and vestibular tests are usually normal.

Other Factors That Can Influence Dizziness

Dizziness can also be influenced by factors such as ageing, autoimmune conditions, allergies, anxiety, and stress. An often overlooked cause is hyperventilation — a shallow breathing pattern commonly associated with anxiety that can trigger or worsen dizziness and vertigo.

What Should I Do If I Experience Dizziness or Vertigo?

If dizziness or vertigo does not resolve on its own, contact your general practitioner. They may refer you to an ENT specialist (also known as an ORL in French‑speaking Switzerland) or directly to my practice. If symptoms suggest a central cause, medical assessment is important and should not be delayed.

BPPV

Benign Paroxysmal Positional Vertigo (BPPV)

If you experience brief episodes of spinning vertigo that are triggered by changes in head position — such as looking up or down, bending forward, or rolling over in bed — you may have BPPV. The spinning sensation typically lasts between 5 and 15 seconds.

What Is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo. It refers to vertigo that occurs suddenly when you change position. If the spinning sensation is constant, it is unlikely to be BPPV and another cause should be considered, such as inflammation of the inner ear. The term benign means that the condition is not dangerous, although the symptoms can be very unpleasant and anxiety‑provoking.

What Happens in the Inner Ear?

Inside the inner ear is the vestibular labyrinth, which contains three semicircular canals filled with fluid. These canals detect rotational head movements. When you move your head, the fluid moves and stimulates sensory hair cells, sending signals to the brain.

Adjacent to the canals are the utricle and saccule, which detect linear movements such as moving forward or up and down. These organs contain tiny crystals called otoconia. In BPPV, some of these crystals become dislodged and migrate into one of the semicircular canals. When they move within the canal, they disturb the normal fluid movement and send false signals to the brain, causing vertigo.

When the crystals move freely, this is called canalithiasis and symptoms usually last a few seconds. When the crystals adhere to the sensory structure, it is called cupulolithiasis and symptoms may last longer.

Treatment for BPPV

BPPV is treated with specific repositioning manoeuvres. During your first session, I assess whether BPPV is present and determine which canal is involved. I then perform the appropriate manoeuvre to guide the crystals back to where they belong. Many patients feel significant relief immediately.

A follow‑up session is used to confirm that the treatment was successful. Sometimes the manoeuvre needs to be repeated, or additional treatment is required if other factors contribute to ongoing dizziness.

With an accurate diagnosis and appropriate vestibular physiotherapy, most causes of dizziness and vertigo can be effectively treated, allowing you to regain balance, confidence, and quality of life.

Balance

Although we rarely think about it, balance depends on a highly sophisticated system.

It relies on three main sensory inputs:

Vision, which helps you see where you are and where you are going
The vestibular system, located in the inner ear, which detects head movement
Proprioception, sensory information from muscles and joints that tells your brain where your body is in space

The information from these three systems is integrated and processed by the brainstem, which tells the eyes to maintain a steady vision and the muscles to maintain posture and balance.

How will my balance be measured?

During your session, we will perform a series of tests to assess your static, dynamic, and reactive balance. These tests help us understand how your balance system functions in different situations and guide your treatment plan.

Static balance

Static balance is your ability to maintain your body’s centre of mass over its base of support while at rest. In simple terms, it is your ability to hold a position without wobbling or falling when you are not moving.

Although static balance may seem passive, it is actually a highly active process. As mentioned above, your brain continuously processes information from your eyes, vestibular system (inner ear), and sensory receptors in your muscles and joints to keep you upright.

Examples of static balance in daily life include standing on one leg during a yoga class, waiting in line at the supermarket, or maintaining your balance while standing on a bus.

Static balance forms the foundation for dynamic balance.

During the session, we will perform several tests to assess your static balance as objectively as possible.

Dynamic balance

Dynamic balance is the ability to remain stable while moving. If your body struggles to maintain stability while standing still, more complex movements—such as walking on uneven ground or climbing stairs—become more difficult and increase the risk of falls and injury.

During the session, we will use specific tests to objectively assess your dynamic balance, such as the Dynamic Gait Index.

Reactive balance

While static balance focuses on staying still and dynamic balance on controlled movement, reactive balance is your body’s 'emergency response' system.

It refers to your ability to regain stability after an unexpected external force or sudden disturbance. In everyday life, this might happen when a bus suddenly brakes, when you slip on a rug, or when you trip over an obstacle.

Reactive balance can be more challenging to assess in a clinical setting, but there are several effective ways to evaluate how well your body responds to these unexpected situations.

Tinnitus

It’s 3 a.m. You suddenly wake up and notice a high-pitched beep in one of your ears. Slightly panicked, you get out of bed, walk to the kitchen, drink a glass of water, and wait for the sound to fade.

For many people, tinnitus (or acouphène in French) is a frightening and intrusive experience. It often appears out of nowhere — a sound that wasn’t there before, now suddenly present inside your head. And no, it’s not 'just in your imagination.'

So what is really happening?

What is tinnitus?

Tinnitus is the perception of sound in the absence of an external source. Some patients tell me during their first visit that they suddenly hear an unfamiliar sound in one or both ears. Others explain that they have noticed this sound for years, but that it has only recently started to bother them.

Tinnitus can be experienced in many different ways. Common descriptions include ringing, beeping, humming, hissing, or whirring sounds. In rarer cases, patients report a whooshing sound in rhythm with their heartbeat, or clicking, cracking, or metallic noises.

Scientifically, any sound perceived without an external source is called tinnitus. About half of the people who experience tinnitus also have an increased sensitivity to sound, a condition known as hyperacusis.

How common is tinnitus?

Tinnitus is much more common than many people realise. Most of us have experienced a brief ringing in the ears lasting a few seconds. However, in approximately 15% of the adult population, tinnitus persists for three to six months or longer.

Only a small percentage of this group experiences tinnitus as moderately to severely bothersome. For those individuals, tinnitus can have a significant impact on daily life.

How does tinnitus affects daily life?

Persistent tinnitus may lead to physical symptoms such as restlessness, muscle tension, fatigue, and low energy. It can also contribute to emotional difficulties, including anxiety, sadness, depression, or feelings of hopelessness.

Behavioural changes are common as well. Activities like reading, concentrating, or listening to music may require more effort. Some people begin to avoid noisy environments such as restaurants or bars — either because sound feels uncomfortable (in the case of hyperacusis) or out of fear that the tinnitus might worsen.

Unfortunately, this avoidance often increases attention to the tinnitus, making it feel louder and more intrusive over time. In the long run, this can lead to social withdrawal and isolation.

What causes tinnitus?

Until about 10–15 years ago, tinnitus was mainly attributed to hearing loss. Damage to the hair cells in the cochlea (the hearing organ in the inner ear) — caused by noise exposure, certain medications, or ageing (presbycusis) — was thought to send distorted information to the brain, which the brain misinterpreted as sound.

Today, this explanation is considered incomplete.

Hearing loss does play an important role, but the mechanism is more complex. When damaged hair cells send less information to the auditory cortex, the brain does not simply “do less work.” Instead, it compensates by increasing sensitivity and activity. When the ear sends insufficient input, central auditory neurons may become overactive — a phenomenon often described as “neural chatter.” This abnormal activity can result in tinnitus.

That said, tinnitus can also occur in people without measurable hearing loss, which highlights that tinnitus is primarily a brain-based condition, not just an ear problem.

Is there a cure for tinnitus?

There is currently no universal cure for tinnitus. However, there are several effective treatment approaches that can significantly reduce its impact.

One of the main challenges in tinnitus research is that tinnitus is not a single condition. There are multiple subtypes and several medical conditions associated with tinnitus. As a result, there is no single treatment or 'magic pill' that works for everyone.

There are many different types of tinnitus.

Subjective and objective tinnitus

In the first place, there is a distinction between subjective and objective tinnitus. Most people suffer from subjective tinnitus, which means that only the patient can hear the sound. On the opposite, objective tinnitus can be perceived by the physician. This would be the case with objective pulsatile tinnitus, which is a whooshing noise, usually, with the same rhythm as your heartbeat, that could be heard by your doctor with a stethoscope. It is caused by an increased blood flow in a small artery in the inner ear. There is also an objective sound that can be caused by the twitching of one or two minuscule muscles in the middle ear. This distinctive form is called middle ear tinnitus.

Syndromic Tinnitus

Another sub-type of tinnitus is syndromic tinnitus. It can be caused by otosclerosis (problem with one of the hearing bones in the inner ear), an acoustic neuroma (a tumour on the auditory nerve) or Menière's disease (abnormal amount of fluid in the inner ear).

What steps should I take if I have tinnitus?

The first step is to consult your general practitioner. They may examine your ears using an otoscope to check for earwax buildup or infection. Depending on the findings, they may treat the issue directly or refer you to an ear, nose, and throat specialist (ENT).

An ENT evaluation usually includes a hearing test performed in a soundproof room. For some patients, especially when tinnitus affects only one ear, your doctor may suggest an MRI to check for an acoustic neuroma. While the idea of a scan can feel worrying, most people’s results are completely normal

In specific cases — such as pulsatile tinnitus — blood tests may be ordered to rule out conditions like anaemia or thyroid disorders.

What can physiotherapy do for tinnitus?

One important subtype of tinnitus that responds well to physiotherapy is somatosensory tinnitus. In this form, tinnitus is influenced by increased muscle tension or dysfunction in the neck, jaw, or shoulder region.

Physiotherapy can help by:

Treating muscular trigger points
Treatment of the chest
Treating of the upper cervical spine and temporomandibular joint (TMJ)
Providing tailored home exercises

Even when somatosensory tinnitus is not clearly present, physiotherapy can play an important role in tinnitus management. Evidence-based approaches include education, counselling strategies, neuroplasticity-based techniques, and — in severe cases — sound therapy.

During treatment, I take the time to explain how tinnitus works, answer your questions, and help you understand why your tinnitus is bothersome. Together, we develop a personalised treatment plan that fits your situation and needs.

What is the prognosis?

Misinformation plays a major role in how tinnitus is experienced. Many patients are told that they 'just have to live with it.' While tinnitus may not disappear entirely, there is a great deal you can learn about living well with it.

In fact, around 95% of people experience a significant reduction in how much tinnitus affects them over time.

For most patients, symptoms decrease within the first six months. When tinnitus is accompanied by strong fear or emotional distress early on, this adaptation process may take longer. Anxiety and fear act as amplifiers in the brain, increasing the perceived intensity of tinnitus through activation of the limbic system.

Through breathing techniques, relaxation, and mindfulness-based strategies, physiotherapy can help calm this system and reduce the distress associated with tinnitus.

If you have further questions or would like to discuss your symptoms, feel free to contact me.

Contact