Key Pointers:
- PPPD is a chronic dizziness condition that can persist even when there’s no movement.
- It often follows an episode of vertigo, ear infection, or stressful event.
- Symptoms include imbalance, unsteadiness, and visual motion sensitivity.
- Management involves treating both vestibular and psychological factors.
- Early ENT evaluation helps determine the right approach for symptom control.
What Exactly Is PPPD?
Persistent Postural-Perceptual Dizziness (PPPD) is a long-term condition where a person feels dizzy, unsteady, or lightheaded most of the time, even when sitting or lying still. Unlike brief vertigo attacks, PPPD causes a persistent sensation of imbalance that can last for months. The dizziness is often worse when standing upright, moving the head, or looking at busy visual patterns (such as scrolling on a phone or walking through a supermarket).
What Causes PPPD?
PPPD often begins after another vestibular event, such as:
- Benign paroxysmal positional vertigo (BPPV)
- Vestibular neuritis or labyrinthitis (inner ear inflammation)
- Migraine-associated vertigo
- A panic or anxiety episode
After the initial trigger, the brain continues to perceive imbalance even though the original ear or neurological problem has resolved. In some individuals, stress, fatigue, or anxiety can worsen the sensation of dizziness. This does not mean PPPD is “just psychological,” but rather that the brain’s balance system and stress response are interconnected.
How Is PPPD Different from Vertigo or Motion Sickness?
While vertigo feels like the room is spinning, PPPD causes a constant sense of unsteadiness or rocking, even when the surroundings are still.
Patients often describe it as:
- Feeling as if walking on a boat or soft ground.
- Difficulty focusing when surrounded by moving objects.
- Dizziness triggered by visual movement rather than head motion.
Unlike motion sickness, PPPD symptoms persist even when stationary and can interfere with daily activities such as reading, driving, or shopping.
Who Is More Likely to Develop PPPD?
PPPD can occur in both adults and older children. Some factors may increase the likelihood, including:
- Previous inner ear disorders or chronic vertigo episodes
- Migraine history
- High stress or anxiety levels
- Personality traits such as heightened self-awareness of body sensations
Women tend to be affected slightly more often than men, though anyone can develop PPPD after a balance-related illness.
How Is PPPD Diagnosed?
Diagnosis is usually made by an ENT specialist or neuro-vestibular physician. The evaluation often includes:
- Detailed history-taking: Understanding how and when the dizziness started.
- Physical examination and balance tests: To check for signs of ear or nerve involvement.
- Audiometry or vestibular function testing: To measure hearing and balance response.
- Imaging (if needed): MRI or CT scans may be done to exclude structural brain or ear problems.
Because PPPD does not show up on standard scans, diagnosis is based on symptom patterns and exclusion of other causes.
How Is PPPD Managed?
PPPD management focuses on reducing dizziness, improving balance, and retraining the brain’s response to movement and visual cues. Treatment may include:
- Vestibular rehabilitation therapy: Exercises designed to help the brain adapt to motion and reduce sensitivity.
- Medication: Low-dose antidepressants or anti-anxiety medications may be used to stabilise the brain’s balance networks.
- Lifestyle adjustments: Regular sleep, hydration, and stress management can help reduce triggers.
- Counselling or behavioural therapy: To address anxiety and restore confidence in movement.
Progress is usually gradual. Consistency and multidisciplinary care are key to recovery.
FAQs About PPPD
1. Can PPPD go away on its own? Some people notice gradual improvement over time, especially with lifestyle adjustments. However, many require targeted therapy to fully manage symptoms.
2. Is PPPD a psychological condition? No. PPPD involves both the balance system and the brain’s sensory processing. Anxiety can make it worse but is not the sole cause.
3. How long does PPPD last? Symptoms can persist for three months or longer. Early recognition and treatment can help shorten recovery time.
4. Can children or teenagers get PPPD? Yes, although it is more common in adults, teenagers may develop PPPD after a severe ear infection or stressful life event.
5. When should I see a doctor for chronic dizziness? If dizziness lasts more than a few weeks, worsens with movement, or affects your daily function, it’s best to consult an ENT specialist for assessment.
Get Clarity on Your Dizziness, Don’t Live in Uncertainty
Chronic dizziness can affect confidence, mobility, and overall well-being. The right diagnosis is the first step toward feeling steady again.
At Aurion ENT & Hearing Centre, Dr Liu Jiaying assesses patients with persistent dizziness through a detailed evaluation of ear, balance, and neurological function. Whether symptoms stem from an inner ear issue or a neuro-vestibular disorder like PPPD, understanding the cause helps guide effective management. Call +65 6908 1266 or Book an Appointment to consult Dr Liu Jiaying, ENT Specialist at Aurion ENT & Hearing Centre, located at Farrer Park Medical Centre, Singapore.
Gain balance, stability, and confidence again, starting with an accurate diagnosis.
