Explanation of common diagnoses in my domain of work.

Treatments

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. 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.

When Does Dizziness and Vertigo Occur?

Dizziness or a sense of disequilibrium can occur when one or more parts of this balance system are not functioning properly.

Vertigo occurs when the balance system in one or both inner ears is not working in harmony, causing the brain to mistakenly believe that your head is moving when it isn’t. Because of this false signal, many forms of dizziness are triggered or worsened by movements of the head.

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 within the inner ear and include conditions such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, labyrinthitis, Ménière’s disease, and secondary endolymphatic hydrops.

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 the characteristic sensations of spinning (vertigo), nausea, or general unsteadiness.

While the symptoms can be intense and often feel alarming, it is important to note that peripheral disorders are generally 'benign' in a medical sense. This means that while they are certainly life-disrupting and require proper management, they are typically not life-threatening.

These issues are often categorised as either mechanical, such as the displaced "ear crystals" found in BPPV, or inflammatory, such as a viral infection affecting the nerves in vestibular neuritis.

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

Central Vestibular Disorders

Unlike peripheral issues that stem from the inner ear, central vestibular disorders originate within the brain and are generally less common. These conditions involve changes in how the brain processes vestibular, visual, and postural information by specifically affecting the brainstem, the cerebellum, and the wider communication pathways that connect your balance system to the rest of your brain.

While vertigo can occur, individuals with central disorders more frequently experience motion sensitivity, imbalance, coordination difficulties, or heightened visual sensitivity. It is important to monitor for 'red flag' symptoms that require immediate medical attention, such as sudden difficulties with speech, vision, attention, and memory, or a distinct sensation of being physically pushed to one side.

While this category includes conditions you may have heard of such as Stroke, Multiple Sclerosis, or cerebellar disorders, the two diagnoses I see most frequently in my practice are Persistent Postural Perceptual Dizziness (PPPD) and Vestibular Migraine. These require a deeper explanation as they function differently than structural brain injuries.

Persistent Postural Perceptual Dizziness (PPPD)

PPPD is recognised as a form of Functional Neurological Disorder (FND). While many neurological conditions are caused by structural damage like a scar or a lesion, FND describes a problem with the 'software' of the nervous system rather than the 'hardware.' In the case of PPPD, the brain remains structurally healthy, but the way it sends and receives balance signals becomes disrupted. It is helpful to think of it as a communication error: the brain is stuck in a high alert mode, over processing sensory information that it would normally ignore.

Unlike many other neurological conditions, PPPD involves no structural damage to the brain or inner ear; instead, symptoms arise from altered central processing of balance and sensory information. This shift in processing often follows an initial trigger event such as an episode of BPPV, a concussion, or a period of acute anxiety where the brain remains stuck in a defensive state even after the initial threat has resolved.

Those living with PPPD typically experience persistent, non spinning dizziness or unsteadiness lasting more than three months. These symptoms are often exacerbated by standing, walking, or navigating visually busy environments like grocery stores or crowds. Because the nervous system is functioning in an overly sensitive state, the goal of treatment is often to 'reset and reprogram' the brain that has become 'overprotective.'

Vestibular Migraine
Following a similar pattern of sensory sensitivity is Vestibular Migraine. In this condition, the brain’s processing centers become hypersensitive, leading to episodes of dizziness or vertigo that can last from minutes to several days. Interestingly, many people do not experience a headache alongside their dizziness, though they may have a history of traditional migraines or sensitivity to light and sound.

Because the brain is already in a heightened state of sensitivity, it is common for Vestibular Migraine and PPPD to occur together. Management focuses on stabilising the nervous system through lifestyle adjustments, identifying personal triggers, and specialised exercises designed to help the brain regain its natural calm.

While many people associate migraines with a severe headache, a Vestibular Migraine is a nervous system event that primarily affects balance. In this condition, the brain becomes hypersensitive to sensory input, leading to episodes of dizziness or vertigo that can last anywhere from minutes to several days. Interestingly, many people with this condition do not experience a headache at the same time as their dizziness, though they may have a history of traditional migraines or sensitivity to light and sound.

Like PPPD, Vestibular Migraine is a functional issue where the brain's internal processing centers become over reactive. Common triggers can include stress, lack of sleep, hormonal changes, or certain foods. Because the brain is in a heightened state of sensitivity, it is not uncommon for Vestibular Migraine and PPPD to occur together. Management often focuses on stabilising the nervous system through a combination of lifestyle adjustments, identifying personal triggers, and specialised vestibular exercises to help the brain regain its natural calm.

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; it is 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. These episodes often appear suddenly and can feel quite intense, even though they are short. The spinning sensation typically lasts 2-30 seconds and usually no more than 2 minutes.

What Is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo. It describes vertigo that occurs suddenly when you change the position of your head. Although the sensation can be alarming, it is a common and well-understood condition. If the spinning sensation is constant instead of being brief and triggered by movement, it is unlikely to be BPPV. In these cases, we must consider other causes such as inflammation of the inner ear. The term benign means that the condition is not dangerous, even though the symptoms can be very unpleasant and sometimes 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 movements of the head and play an important role in maintaining balance and stable vision. When you move your head, the fluid inside these canals shifts and stimulates tiny sensory hair cells. These cells send signals to the brain, helping it understand how your head and body are moving in space.

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 that help sense gravity and motion.

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 movement of the fluid and send incorrect signals to the brain, which creates the sensation of vertigo.

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

Treatment for BPPV

BPPV is treated with specific repositioning manoeuvres that aim to move the crystals back to their normal location. During your first session, I assess whether BPPV is present and determine which canal is involved.

Then I perform the appropriate manoeuvre to guide the crystals back to where they belong. Many patients experience significant relief immediately after treatment or within a short time.

A follow-up session helps confirm that the treatment was successful. Sometimes the manoeuvre needs to be repeated, or additional treatment may be recommended 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. The goal is to help you regain balance, confidence, and quality of life so that you can return to your normal activities.

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, they are like the inner ear balance sensors,
Proprioception, sensory information from muscles and joints that tells your brain where your body is in space.

The brainstem integrates input from these three systems with data from the cerebellum and the cerebral cortex. By synthesising these signals, the brain directs the eyes and muscles to maintain balance and keep the body upright.

Think of the cerebellum as your brain’s 'autopilot.' When you first learn a new move, the thinking part of your brain (cerebral cortex) has to work really hard to figure it out. But as you practice, your autopilot takes over, turning those shaky first steps into smooth, automatic 'muscle memory.'

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 individual 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, 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.

Definitions

International Classification of Vestibular Disorders (ICVD)

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.

Tinnitus

It is 3 a.m. You wake up and notice a high pitched sound in one ear. You wait for it to fade, but it does not. You are not imagining it. This is called tinnitus (or 'acouphène' in French).

While tinnitus can feel alarming, in most cases it is not dangerous. The good news is that even when the sound does not completely disappear, its impact can be significantly reduced.

What Is Tinnitus?
Tinnitus is the perception of sound when there is no actual external source present. Because it is a deeply personal experience, people describe it in many ways, such as a constant ringing, beeping, or humming. For others, it feels like a hissing, buzzing, or a whooshing sensation that may move in rhythm with the heartbeat.

The way people first notice tinnitus varies. Some find it appears suddenly, while others realise they have lived with it for years, only noticing it more recently because it has become bothersome. It is also common for this to overlap with hyperacusis, which is an increased sensitivity to everyday sounds.

In my praxis, I help patients see that tinnitus often follows a path of sensory sensitisation similar to PPPD. You can think of it as the brain’s 'volume control' being turned up too high. Just as the balance system in PPPD over processes movement, the auditory system becomes hypersensitive to internal sounds that should normally be filtered out. My goal is to help your nervous system recalibrate so these sounds can eventually fade back into the background.

How Common Is It?
Tinnitus is much more common than most people realise. Around 15% of adults experience persistent tinnitus. While it can interfere with sleep, concentration, and mood, only a small percentage of people find it severely distressing. In those cases, professional support is an essential part of finding relief.

Is Tinnitus Dangerous?
In the vast majority of cases, tinnitus is not a sign of a serious disease. However, a medical evaluation is recommended if you experience tinnitus in only one ear, a pulsating sound, sudden hearing loss, or associated dizziness. Most examinations turn out completely normal, which is a reassuring sign that the brain and ears are structurally healthy.

What Causes Tinnitus?
Tinnitus often begins with a modification in your hearing system. When the inner ear transmits less information to the brain, whether due to loud noise exposure, the natural ageing process, or even a minor loss of hearing, the brain does not simply become quieter. Instead, it attempts to compensate for this missing information by increasing its own internal activity.

You can think of this as the brain turning up its internal gain or sensitivity to search for the signals it expects to hear. This increased neural activity is what we eventually perceive as sound. For this reason, we now view tinnitus primarily as a change in how the brain processes sound, rather than simply a problem with the ears. In some patients, the brain also receives 'misfired' signals from the neck and jaw muscles. Because the nerves in the upper spine and jaw are physically connected to the auditory centers in the brain, physical tension can sometimes influence the sound you hear.

Importantly, the sound itself is not the main issue; it is the way the brain reacts to the sound. When tinnitus triggers the limbic system (the brain’s 'alarm system'), it increases your attention to the sound, making it seem louder and more intrusive. Understanding this mechanism is the first step toward retraining the brain.

How Can Physiotherapy Help?
While not all tinnitus is caused by physical tension, physiotherapy is a valuable tool for a specific group of patients. For those with somatosensory tinnitus, addressing issues in the neck or jaw can help reduce the intensity of the sound. Treatment for this group may involve manual therapy of the cervical spine, jaw (TMJ) work, and postural correction.

For patients where a physical cause is less prominent, physiotherapy remains an important part of the journey by calming the nervous system. By focusing on breathing, relaxation techniques, and reducing the body’s 'fight or flight' response, we can decrease hypervigilance and improve sleep. Whether the sound changes physically or the brain simply learns to ignore it more effectively, the goal is to help your body feel safe again.