Understanding Dizziness, Spinning Sensations, and Imbalance.
Vertigo and balance problems are among the most common reasons adults visit an ENT clinic in Singapore. These symptoms may range from brief spinning episodes to persistent unsteadiness that disrupts work, daily activities, and quality of life.
At Aurion ENT & Hearing Centre, ENT Specialist Dr Liu Jiaying has extensive fellowship training in otology and vestibular disorders, with strong expertise in conditions like BPPV, PPPD, vestibular migraine, and eustachian tube-related dizziness.
What causes vertigo?
Vertigo occurs when there is a problem in the:
- Inner ear balance organ (vestibular system)
- Vestibular nerve
- Brain’s balance coordination centres
Common causes include:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular neuritis / labyrinthitis
- Vestibular migraine
- Persistent Postural-Perceptual Dizziness (PPPD)
- Eustachian tube dysfunction
- Inner ear disorders causing fluid imbalance
- Neck-related dizziness (cervicogenic)
- Circulatory or neurological causes
Understanding whether your dizziness is ear-related or neurological is essential for proper treatment.
Is my vertigo ear-related or neurological?
Signs vertigo is ear-related:
- Room feels like it is spinning
- Triggered by head movement or turning in bed
- Short-lived episodes (seconds to minutes)
- Ear fullness, tinnitus, or hearing changes
- Nausea improves when sitting still
Signs dizziness may be neurological:
- Imbalance even when still
- Difficulty walking or coordinating movements
- Double vision, facial droop, speech difficulty
- Severe headache
- Symptoms lasting many hours or days without improvement
Red-flag neurological features require urgent medical evaluation.
What Are the Common Balance Disorders
1. BPPV (Benign Paroxysmal Positional Vertigo)
BPPV is the most common cause of vertigo.
Caused by displaced calcium crystals in the inner ear, it triggers:
- Sudden spinning when turning in bed
- Dizziness triggered by head movement
- Short episodes lasting seconds
- Nausea and imbalance
- Recurrence if untreated
BPPV is diagnosed through simple positional testing and treated with repositioning manoeuvres.
2. PPPD (Persistent Postural-Perceptual Dizziness)
PPPD is a chronic functional vestibular condition.
Common symptoms:
- Persistent unsteadiness lasting >3 months
- Feels worse when standing, moving, or walking
- Symptoms triggered by visually busy environments (e.g., supermarkets)
- Often starts after a viral infection or previous vertigo attack
PPPD is not dangerous, but it can significantly impact comfort and confidence. Management includes:
- Vestibular therapy
- Lifestyle adjustments
- Targeted medical treatment if required
3. Vestibular Migraine
Migraine can cause dizziness even without headache.
Warning signs:
- Vertigo lasting minutes to hours
- Motion sensitivity
- Light or sound sensitivity
- On-and-off dizziness with no clear pattern
- History of migraine or family migraine tendency
Vestibular migraine is treatable once accurately diagnosed.
When is vertigo an emergency?
Seek urgent care if you experience:
- Vertigo with severe headache
- Slurred speech
- Weakness or numbness in arms/legs
- Difficulty walking
- Double vision
- Sudden hearing loss
- Persistent vomiting
These may indicate stroke, severe neurological disorders, or sudden sensorineural hearing loss.
How do ENT doctors assess dizziness?
At Aurion ENT, dizziness evaluation includes:
1. Detailed history
- Onset, pattern, triggers
- Ear symptoms
- Migraine history
- Balance difficulties
2. Positional testing
- Dix-Hallpike test for BPPV
- Balance and gait assessment
3. Ear & hearing evaluation
- Ear examination
- Hearing tests
- Tympanometry
- Assessment for eustachian tube dysfunction
4. Nasoendoscopy (if needed)
To assess sinus or nasal contributors affecting pressure balance.
5. Imaging or referrals
Only when neurological causes are suspected.
Vertigo Symptom Checker
Identify patterns that may help you understand the cause of your dizziness.
(This does not replace medical assessment.)
1. “The room is spinning.” → Likely vertigo
Possible causes:
- BPPV
- Inner ear inflammation
- Vestibular disorders
2. “I feel off-balance all day.”
Possible causes:
- PPPD
- Vestibular migraine
- Chronic vestibular dysfunction
Worse with:
- Movement
- Standing
- Busy visual environments
3. “I feel dizzy when turning in bed.”
Strong suspicion for BPPV.
4. “Headache + dizziness.”
Possible vestibular migraine.
5. “Ear fullness or ringing + dizziness.”
Possible:
- Inner ear fluid problem
- Eustachian tube dysfunction
- Early Meniere’s disease
6. “I can’t walk straight.”
Neurological concern — urgent evaluation needed.
7. “Dizziness after a flu.”
Possible vestibular neuritis.
8. “My child feels dizzy.”
Children may have:
- Migraine variants
- Middle ear infections
- Viral balance issues
Seek Children ENT review if recurrent or affecting mobility.
FAQ: Vertigo & Balance Disorders
What is vertigo?
Vertigo is the sensation of spinning or movement when you are still. It is commonly caused by inner ear disorders but may also arise from neurological conditions.
What is the most common cause of vertigo?
BPPV is the most common cause and is triggered by displaced crystals in the inner ear that disturb the balance system.
How do ENT doctors test for vertigo?
ENT doctors perform positional tests such as the Dix-Hallpike manoeuvre, ear examination, and hearing assessments to determine whether your dizziness is ear-related.
Can sinus issues cause dizziness?
Yes. Sinus congestion or pressure changes can contribute to dizziness, though persistent symptoms should be evaluated to rule out inner ear causes.
What is PPPD?
PPPD is chronic dizziness lasting more than three months, often worsened by movement or busy environments. It commonly follows a previous vertigo or balance event.
Is vertigo dangerous?
Most vertigo is benign, but red flags like sudden hearing loss, weakness, or difficulty walking require emergency assessment.
Can children get vertigo?
Yes. Children may develop dizziness from migraine variants or ear infections. Any persistent or recurrent symptoms should be evaluated by a Children ENT specialist.
Need help with vertigo or persistent dizziness?
You don’t have to live with spinning, imbalance, or constant unsteadiness.
Aurion ENT & Hearing Centre provides comprehensive evaluation for:
- BPPV
- Vestibular Migraine
- PPPD
- Eustachian Tube Disorders
- Adult ENT & Children ENT Balance Issues
Speak with ENT Specialist Dr Liu Jiaying — Vestibular-trained, experienced in complex dizziness conditions.
