Dizziness, Imbalance and Vertigo: How to Get Better

I thought it was high time for an update on the very common problem of dizziness, imbalance and vertigo in Singapore. My last blog on this interesting topic was a few years ago! That last blog on dizziness was so popular that my patient called me “the Queen of Dizziness”. I’m honestly not too sure what to make of that label! I guess I took a break from blogging about dizziness for a while!

We have helped so many patients with dizziness, imbalance and vertigo at our busy ENTcare Clinic in Singapore. I’ve lost count but I think the numbers are probably in the thousands by now. It started from my days as an ENT specialist registrar training in London. Afterward, I completed a Neurotology Ear fellowship in Hearing and Balance in Toronto, Canada for a year.

HAVE YOU SEEN TOO MANY DOCTORS FOR YOUR DIZZINESS AND VERTIGO?

Sadly, many dizzy patients spend lots of money and time on a “merry-go-round of doctors”. They see multiple doctors of different specialties. First, they see Neurology then Cardiology. Then they see ENT, maybe another ENT specialist and finally, Psychiatry. Actually, they should see an experienced Neurotologist for their dizziness. Neurotologists are ENT super-subspecialists in dizziness, imbalance and vertigo disorders. Can you believe the record number of doctors that my patient had seen before me, was TEN?!

Dizzy patients can turn up in any doctor’s clinic! The question is whether that doctor knows how to manage the dizzy condition or just refer you off to another specialist. Here’s a very interesting fact: CT and MRI brain scans are often NORMAL in many dizzy patients. Even more so if due to an underlying inner ear disorder. Therefore you cannot depend on scans to diagnose some inner ear causes of dizziness.

Rarely, some patients have small inner ear tumours which are the cause of their symptoms. MRI scans pick these tumours up.

WHAT IS THE MOST IMPORTANT CONCERN WITH A DIZZY PATIENT?

Most importantly, in any dizzy patient, we need to exclude a sudden stroke in the posterior fossa of the brain. Rarely, some inner ear and brain tumours may present with dizziness, tinnitus (noise in ear) and hearing loss. The list of dizzy conditions is endless! This includes cardiac, neurological, hormone, gastrointestinal and psychological issues. It can be challenging to track down the actual cause of dizziness. Do you know that some dizzy patients have more than just one cause?

For example, some dizzy patients may have started off with an inner ear infection which did not fully recover. Then they developed secondary anxiety and panic attacks which makes them feel even dizzier. Some dizzy patients also suffer recurrent headaches and may turn out to have vestibular migraine. This is a special migraine that presents with headaches AND dizziness. Vestibular migraine is often triggered by stress, anxiety and computer screentime.

IS MY DIZZINESS, IMBALANCE AND VERTIGO TREATABLE?

The strange thing about dizziness, imbalance and vertigo conditions, is that it might be easily treatable like Benign Positional Paroxysmal Vertigo (BPPV). BPPV is the commonest ear-related vertigo and dizziness condition! In BPPV, calcium crystals become loose and irritate the inner ear. So patients with BPPV suffer recurrent attacks of vertigo, lasting typically a few seconds. BPPV is easily treatable but needs to be correctly diagnosed. Why? So that we know which ear and what type of treatment manoeuvre to do!

You’re not going to diagnose BPPV using a brain scan because the crystals are just too tiny. The answer is definitely NOT longterm medication! For more resistant rare cases of BPPV, they need surgery to plug off the affected part of the inner ear. Even seemingly unrelated conditions such as nasal allergies and sinus infections, can cause dizziness.

WHAT ARE MORE WORRYING EAR CAUSES OF DIZZINESS, IMBALANCE AND VERTIGO?

Sometimes, it might be something that really destroys your quality of life such as Meniere’s disease. The poor patient suffers recurrent dizzy attacks of vertigo, a blocked ear fullness and fluctuating hearing loss. This type of hearing loss can be temporary but may not always recover. It is usually the dizziness that disturbs the patient the most, compared to the hearing loss.

Enlarging cysts of trapped skin growing behind the eardrum called cholesteatomas can also erode into the inner ear to cause dizziness and imbalance. These skin tumours should be surgically removed to prevent further destruction of inner ear structures. Surgery is advised when we detect them because there is no medication to make them go away. Chronic eardrum infections, are also abnormal. These may lead to deeper infection to cause vertigo and dizziness.

So now you know how challenging it is to diagnose and treat a dizzy patient properly! How important it is to do so to help the dizzy patient feel better. Clear explanation of the dizzy problem is often half the battle won. Bringing your family with you to see the doctor is a very good idea! Ask the doctor all the questions you or your family might have, to make sure everyone is on the same page. Some patients even bring their spreadsheets and paper to take notes!

In the meantime, if you suffer a sudden dizzy attack, what can you do? Please don’t panic because this will just raise your blood pressure.

Here are Dr Annabelle’s Dizzy Tips:

1. Do NOT Panic if you start to feel dizzy. Instead, take a few deep breaths and lie down to rest somewhere without bright lights.
2. Take medications such as Stemetil (prochlorperazine) or cinnarizine. They won’t “cure” your underlying condition but they often help to suppress any inner ear irritation to ease the dizziness. Avoid taking these medications longterm as they can affect your natural recovery.
3. Most benign dizzy conditions will settle down within a few seconds to minutes. So try to find out which head position seems to trigger it. Then make a mental note to tell your friendly ENT specialist in Singapore when you see her.
4. If you have a headache associated with the dizziness, try some simple painkillers like Panadol and take a rest. If they tend to recur, it might be helpful to keep a dizzy diary to see if a pattern emerges.
5. Stop any computer work or screentime you might be doing. Too much screen time might be the trigger for your dizziness.
6. High levels of stress can be a trigger!

WATCH OUT FOR THESE RED FLAGS! YOU MAY NEED TO GO TO A&E IF:

1. The dizziness doesn’t seem to improve within a few hours.
2. Severe nausea and vomiting
3. Severe headaches
4. Visual blurring
5. Slurred speech
6. Facial numbness or weakness
7. Numbness or weakness of your arm or leg
8. Drooling or difficulty swallowing
9. Hearing loss in one ear
10. Drowsiness

The list of causes of dizziness and vertigo is endless! It is important that we exclude more worrying problems but we also need to diagnose the cause itself. If you or your family member suffer from dizziness, come see me for a clear opinion. It is always better to treat your dizziness early, rather than leave it too long. The success rates of recovery are higher for sure!

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