Explanation of common diagnoses in my domain of work.

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

Dizziness

It’s no exaggeration to say that explaining your symptoms can be challenging. How do you accurately describe what happened or how you feel to your healthcare provider? This can be particularly difficult with dizziness-related symptoms.

After all, 'dizziness' can mean very different things to different people.

How will I help you?

When you are referred to my practice, we start with a comprehensive intake consultation. You will have the time and space to tell your story in your own words. Together, we will clarify and define your symptoms.

If needed, I will ask targeted questions and perform specific tests. Based on this assessment, we will form a clear hypothesis or diagnosis. Because dizziness can have many causes, treatment is always individual. Together, we will develop a personalised treatment plan aimed at improving your symptoms or resolving the problem.

What is dizziness?

Many patients use the word dizziness as a general term to describe their symptoms. Medically, it often refers to sensations such as lightheadedness, faintness, or unsteadiness.

Some people describe the feeling as walking on a boat or as if they have had one glass of wine too many. Others experience a “cotton wool” sensation in the head, also known as brain fog.

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

How do we keep our 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

Your brain integrates this information to stabilise your vision and maintain posture and balance.

You can find more information in the section on 'balance'.

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 known as a vestibular disorder.

Peripheral vestibular disorders

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

Benign paroxysmal positional vertigo (BPPV)
Labyrinthitis
Vestibular neuritis
Ménière’s disease
Secondary endolymphatic hydrops

You can find more information about BPPV in the section on vertigo.

Central vestibular disorders

Central vestibular disorders originate in the brain and are less common. They are often related to vascular conditions.

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

Are there other factors that can influence dizziness?

Dizziness can also be influenced by ageing, autoimmune conditions, allergies, anxiety, and stress.

An often overlooked stress-related cause is hyperventilation—a shallow breathing pattern linked to 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).

If dizziness is suspected to be of central origin, it is important to seek medical advice as soon as possible.

Vertigo

If you have a spinning sensation in your head that gets suddenly provoked when you change positions, and when the real spinning last between 5 and 15 seconds, then you may have a BPPV. Typically you will notice this when you look up or down or roll over to one side in bed.

What is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo. It's a mouthful for saying that it's vertigo that suddenly (paroxysmal) appears when you change your position. Which means that if the actual spinning is all the time there, it’s very likely not a BPPV and it could be another pathology, e.g. an inflammation in the inner ear. The 'benign' part means that you don't have to worry; it's just a mechanical problem. Still, vertigo can be very limiting for your daily activities and provokes quite a bit of anxiety in some patients.

So what happens exactly?

The answer lies in the vestibular labyrinth. You can see in the image underneath, inside the inner ear an organ with three arc-shaped structures. These are the three semicircular canals; they are filled with fluid and provide us with information about motion, body position and spatial orientation. When you move your head, then the fluid in these canals will move as well. At the end of each canal, you have little hair cells. When they are set in motion by the fluid, they will send a signal about the movement of your head to the brain.

Adjacent to these canals is a space that is called the vestibule, in here we find the utricle and saccule. These two otolith organs play another essential role in the detection of movement; they help to detect linear acceleration. So it tells your body when you move forwards, e.g. when you drive a car. Or when you move upwards and downwards, like in an elevator.

What's more important for this story, is that they have little particles embedded in a layer of gel, which are called otoconia. These tiny crystals can become dislodged from the gel and migrate into one or more of the semicircular canals, where they are not supposed to be. When enough of these particles accumulate in one of the canals, they interfere with the normal fluid movement, causing the inner ear to send false signals to the brain. At that moment, you will experience a spinning sensation. It usually lasts 5-15 seconds; the amount of time that the otoconia move through your canals. When they move freely through the canal, we speak about canalithiasis. Unfortunately, sometimes they might be stuck; in this case, you have a cupulolithiasis. The spinning sensation can last with the latter variation longer, up to minutes or more.

What can I do about it?

If your symptoms sound familiar with what I described before, then you can ask your doctor for a prescription for physical therapy. In the initial treatment session, I will first of all examine if you have a BPPV, and secondly in which canal(s) the crystals are stuck. After that, I will use some specific manoeuvers, to put these crystals back in the vestibule. Here they won't bother you anymore. Most of my patients feel immediately a lot better after a succeeded manoeuvre.

In the second session, I will control if the manoeuvre performed in the first session worked and if all symptoms are gone. Sometimes I have to repeat the manoeuvre a second or third time. In some cases, the manoeuvre worked, but there can be other causes that provoke dizziness or vertigo.

Balance

We don’t often think about how we can keep our balance, but it’s an incredible ingenious system.

Let’s try to explain this as simply as possible. Your body’s balance system relies on three senses.

You can keep your balance through vision to see where you are going,

your vestibular system (the balance organ in your inner ear, that gives out signals when your head moves) and proprioception (touch sensors in your body that allow you to feel where you are going).

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