"Dizzy" covers several different sensations, and the first step to getting help is working out which one you have. A room that spins, a faint feeling when you stand up, and an unsteady, floating walk each point to a different set of causes and a different kind of doctor. Most dizziness is not dangerous and many causes are easy to treat, but a small number signal a stroke and are an emergency. This article explains how to tell them apart, what the common conditions look like, and what to expect from an ENT visit. For vertigo treatment in Guwahati, UHS Vista has an ENT team including a vertigo specialist at its South Sarania centre.
Vertigo or Lightheadedness?
Vertigo is a false sense of movement, usually spinning, as though you or the room are turning. It comes from the balance system: the inner ear, the nerves that connect it to the brain, or the brain itself. Nausea, vomiting and a tendency to fall to one side often go with it.
Lightheadedness is a feeling of being about to faint, with grey vision and weakness, usually on standing up. It points to blood flow to the brain, not to the ear.
Disequilibrium is unsteadiness when walking, with no spinning. It is more common in older adults, and can come from nerve damage in the feet, poor vision, medicine side effects, or conditions affecting the brain.
Describe it to your doctor in these terms. "I feel the room spinning when I turn over in bed" gives far more information than "I feel dizzy".
The Common Causes of Vertigo
BPPV (benign paroxysmal positional vertigo)
This is the most common cause of true vertigo. Tiny calcium crystals in the inner ear drift into one of the balance canals and send false signals when the head moves. The pattern is distinctive:
- Brief spinning, usually under a minute, triggered by a particular head movement: rolling over in bed, looking up at a shelf, bending down, or tilting the head back at the hair wash
- Normal in between attacks, though some people feel off-balance for hours after
- No hearing loss and no ringing in the ears
The diagnosis is made in the clinic with positional tests such as the Dix-Hallpike manoeuvre, which brings on the vertigo and a typical eye movement. Treatment is a series of head movements, such as the Epley manoeuvre, that guide the crystals back to where they belong. It works in most people within one to three sessions. BPPV can come back, and the same manoeuvre can be repeated. Trying a manoeuvre at home from a video can send the crystals the wrong way or use the wrong side, so it is best done after a proper examination.
Vestibular neuritis and labyrinthitis
A viral inflammation of the balance nerve causes sudden, severe, constant vertigo lasting days, with nausea and vomiting, often after a cold. If hearing is also affected, it is called labyrinthitis. The worst is over in a few days, with gradual improvement over weeks as the brain compensates. Short-term medicines help the nausea, but staying in bed for long delays recovery, and gentle movement and balance exercises are encouraged once the worst has passed.
Meniere disease
Episodes of vertigo lasting from about twenty minutes to several hours, together with fluctuating hearing loss, ringing in the ear, and a feeling of fullness. Repeated attacks may leave lasting hearing loss. A hearing test is essential to diagnose it, and management includes reducing salt, treating attacks, and sometimes preventive medicine.
Vestibular migraine
Vertigo that comes with headache, sensitivity to light or sound, or a history of migraine, but sometimes with no headache at all. It is far more common than people realise, and is managed with migraine triggers, preventive medicines and lifestyle changes.
Ear infections and wax
Middle ear infection, fluid behind the eardrum, or a blocked ear can all cause a sense of imbalance. An ear examination is one of the first and simplest steps.
Dizziness That Is Not Vertigo
If the main problem is feeling faint or unsteady on standing, the cause is more often one of these:
- Postural (orthostatic) low blood pressure: a drop in blood pressure on standing, from dehydration, long bed rest, blood pressure tablets, diabetes affecting the nerves, or heart rhythm problems. A blood pressure check lying and then standing is the simple test.
- Anaemia: iron or B12 deficiency can cause dizziness, tiredness and breathlessness. See our guide on Vitamin D and B12 tests.
- Low or high blood sugar: especially in people on diabetes medicines. Our guide to the HbA1c test explains the numbers.
- Anxiety and panic: can cause lightheadedness, tingling and a sense of unreality.
- Medicines: sedatives, some blood pressure and anti-epileptic drugs, and many other tablets list dizziness as a side effect.
- Heart rhythm problems or valve disease: especially when dizziness comes with palpitations or fainting. An echocardiogram and ECG are part of that work-up.
Neck problems are often blamed for dizziness, and "cervical vertigo" is a common explanation in clinics. True dizziness caused by the neck is uncommon and hard to prove, so other causes should be ruled out before attributing it to cervical spondylosis.
When Dizziness Is an Emergency
Vertigo from a stroke in the back part of the brain can look just like an inner ear problem. Go to an emergency department immediately if dizziness comes with any of the following:
- Sudden, severe headache or neck pain
- Double vision, loss of vision, or difficulty speaking or swallowing
- Facial droop, numbness, or weakness in an arm or leg
- Inability to stand or walk even with support, or falling to one side
- Loss of consciousness
- Vertigo that begins after a head or neck injury
Risk is higher in people with high blood pressure, diabetes, high cholesterol, atrial fibrillation, or a history of smoking. Do not wait to see whether it passes.
What Happens at an ENT Visit for Vertigo
A doctor usually begins with questions: how long each episode lasts, what triggers it, whether hearing or ringing changes, recent infections, medicines and headaches. These details narrow the diagnosis more than any test. Then:
- Ear examination for wax, infection and the eardrum
- Positional tests such as Dix-Hallpike for BPPV
- Eye movement and balance tests to separate inner ear from brain causes
- Hearing test (audiometry) if hearing loss or ringing is present
- Blood pressure, blood sugar and blood tests to look for non-ear causes
- Imaging, usually MRI, only when a brain cause is suspected
Most people with positional vertigo need only the examination and a manoeuvre.
Managing Vertigo at Home
- Avoid sudden head movements during an attack, and sit down at the first sign of one.
- Remove loose rugs, light the way to the bathroom at night, and use a rail on stairs to prevent falls.
- Do not drive or climb ladders while episodes are active.
- Take vestibular suppressant medicines only as prescribed and for a short time. Used for long, they slow the brain's natural recovery.
- Drink enough fluids, reduce excess caffeine and alcohol, and sleep regularly, since these can trigger or worsen dizziness.
- Once the acute phase is over, vestibular exercises taught by a physiotherapist or doctor help the brain adapt.
Frequently Asked Questions
Why do I feel dizzy when I turn over in bed?
Spinning that lasts under a minute and is triggered by turning in bed or looking up is the classic pattern of BPPV. It is easily treated, so get it checked.
Can anxiety cause vertigo?
Anxiety can cause lightheadedness and a sense of unsteadiness, and long-term dizziness can cause anxiety in turn. A proper examination is needed to separate them.
Is vertigo a sign of a brain tumour?
Rarely. Most vertigo comes from the inner ear. A slow-growing tumour on the hearing and balance nerve usually causes gradual one-sided hearing loss and ringing before dizziness, and is looked for if the hearing test is abnormal on one side.
How long does vertigo last?
BPPV episodes last under a minute but can recur for weeks until treated. Vestibular neuritis causes several days of severe vertigo followed by weeks of recovery. Meniere episodes last hours.
Should I see an ENT doctor or a neurologist?
Start with an ENT specialist if the dizziness is spinning, triggered by position, or comes with ear symptoms. A general physician is a good first stop for faintness on standing. Stroke symptoms need an emergency department.
Vertigo and Dizziness Care at UHS Vista
Our ENT department includes Dr. Paramita Chakraborty, a vertigo specialist, along with Dr. Munindra Narayan Baruah and Dr. Debadeep Bagchi for ear, nose and throat problems. For dizziness related to blood pressure, sugar, anaemia or heart rhythm, our internal medicine and cardiology teams can examine you and run the in-house blood tests and echo on the same visit. Book an ENT appointment or call +91 92879 88515.
Visit us: Dwarka Centre, Saniram Bora Road, behind Bora Service, South Sarania, Lachit Nagar, Guwahati, Assam
Timings: Monday to Saturday, 7:30 AM to 8 PM. Sunday, 7:30 AM to 1:30 PM.
Contact: +91 92879 88515 | uhsvista@gmail.com
