About the vestibular system
Two small organs in each inner ear — the semicircular canals and the otolith organs — sense
head movement and gravity. They send constant signals to the brainstem, which combines them
with vision and joint position to keep you upright and stable.
When this system misfires — a misplaced inner-ear crystal, an inflamed nerve, fluctuating fluid
pressure, or a migraine pathway — the result is vertigo or imbalance. Most causes are benign
and treatable; a few warrant urgent imaging. Sorting them out is the job of a structured
clinic visit.
Symptoms that warrant an assessment
- A spinning sensation triggered by head movement (rolling in bed, looking up)
- Episodes of severe vertigo lasting minutes to hours, with nausea
- A persistent feeling of imbalance — as if walking on a boat
- Hearing changes, fullness, or tinnitus accompanying the dizziness
- Recurrent falls, especially in older adults
- Dizziness associated with severe headaches or visual aura
See us urgently if you have sudden severe vertigo with hearing loss, slurred speech,
weakness on one side of the body, double vision, or a severe new headache — these point to
central causes that need same-day workup.
Conditions we commonly assess
BPPV
Brief positional spins from misplaced inner-ear crystals — the most common cause, and very effectively treated with a single repositioning manoeuvre.
Vestibular neuritis / labyrinthitis
Inflammation of the balance nerve, usually post-viral. Severe acute vertigo that settles over days, with persistent imbalance for weeks. Benefits from vestibular rehabilitation.
Meniere's disease
Recurrent episodes of vertigo with fluctuating hearing loss, ear fullness, and tinnitus. Managed with diet, lifestyle, and medication; rarely surgery.
Vestibular migraine
Episodic dizziness linked to migraine pathways — increasingly recognised. Often responds well to migraine prophylaxis and trigger management.
Persistent postural-perceptual dizziness
Chronic imbalance that often follows an acute vestibular event. Anxiety and visual sensitivity contribute. Vestibular rehab and CBT are the mainstays.
Age-related imbalance
Reduced vestibular reflex with age, often layered with vision, joint, and medication factors. A multi-component plan reduces falls meaningfully.
What the assessment involves
The visit is structured to reach a working diagnosis in 45–60 minutes, with treatment starting the same day when possible.
- Detailed history — onset, triggers, duration, accompanying ear or visual symptoms, medications.
- General ENT examination — otoscopy and basic cranial-nerve review.
- Dix-Hallpike manoeuvre — the bedside test for posterior-canal BPPV.
- Supine roll test — for horizontal-canal BPPV.
- Head impulse test & gaze nystagmus — to distinguish peripheral from central causes.
- Gait and Romberg — observation of balance during walking and standing.
- Audiometry & tympanometry — to look for the hearing pattern of Meniere's or other inner-ear conditions.
- Imaging when indicated — MRI for suspected central or retrocochlear causes.
Treatment & management options
Treatment is matched to the diagnosis. Most patients leave the first visit with a clear plan and, very often, meaningful relief.
- Epley manoeuvre and other particle-repositioning techniques for BPPV — typically resolves symptoms in one or two sessions.
- Vestibular rehabilitation therapy (VRT) — supervised exercises that retrain balance pathways. Highly effective in chronic and post-viral cases.
- Short-course vestibular suppressants for acute attacks — used briefly to avoid delaying central compensation.
- Diet and lifestyle plan for Meniere's — low salt, hydration, sleep, stress.
- Migraine prophylaxis for vestibular migraine — often the single most useful step in this group.
- Co-ordination with neurology when imaging or evaluation suggests a central cause.
- Cervical spine and visual review when indicated — dizziness is often multi-factorial in older adults.
What to expect at your visit
- Wear comfortable, loose clothing — some tests involve lying back quickly.
- Bring a companion if you feel unsteady — they help during walking tests and the journey home.
- Bring previous reports (MRI, audiograms, ENT or neurology notes) and a current medication list.
- Eat a light meal beforehand — empty stomach can worsen nausea during manoeuvres.
- Avoid driving immediately after a positional manoeuvre — the room can feel unsteady for a few hours.
BPPV — the commonest culprit — is treated in 10–15 minutes with the Epley manoeuvre,
and the majority of patients leave significantly better than they came in.