Dizziness, Giddiness, Imbalance and Vertigo: How to Get Better

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

We have seen and helped so many dizzy and giddy patients over the years at our busy ENT clinics in Singapore. I’ve frankly lost count but I think the numbers are probably in the thousands by now, starting from my days as an ENT specialist registrar training in London and then going on to a Neurotology Ear fellowship in Hearing and Balance at the Toronto General and Toronto Western Hospitals in Canada for a whole year! Sadly, many dizzy patients have used up a lot of their funds and time going round what I call “the merry-go-round of doctors”, seeing multiple doctors of different specialties and getting referred from Neurology to Cardiology, to ENT, then off to another ENT specialist, then perhaps off to Psychiatry then Endocrine/Hormone before they finally realise they need to come and see an experienced Neurotologist for a clear and precise opinion on their dizzy condition. Neurotologists, by the way, are ENT super-subspecialists in dizzy, hearing and balance disorders.Can you believe the record number of doctors that one of my patients had seen before she finally came to see me, was TEN different doctors from various specialties?!?

Dizzy patients can turn up in any doctor’s clinic, from your family doctor to different specialists. The question is whether that doctor knows how to manage the dizzy condition or whether they are just going to refer you off to yet another specialist. Here’s a very interesting FACT: CT and MRI brain scans are often NORMAL in many dizzy patients, especially if the dizzy condition is caused by an underlying inner ear disorder. Yes, although scans are useful to investigate some causes of dizziness, they are unable to detect many inner ear causes of dizziness!

Of course, the most important priority in any dizzy patient is to make sure that the symptoms is not due to a sudden stroke in the posterior fossa, the “back” portion of the brain. Rarely, some inner ear and brain tumours may present with dizziness, tinnitus (noise in ear) and hearing loss, so we always bear this in mind when we examine dizzy patients. As the list of dizzy conditions is endless, including cardiac, neurological, hormone, blood-pressure, gastrointestinal and psychological issues, it can be challenging to track down the actual cause of dizziness and sometimes, dizzy patients have concurrent dizzy causes i.e. not just one isolated cause. For example, some dizzy patients may have started off at the start with an inner ear infection which perhaps did not fully recover, then they went on to develop secondary anxiety and panic attacks which subsequently makes them feel even dizzier. Some dizzy patients who also suffer recurrent headaches may also turn out to have vestibular migraine, a special type of migraine that can present with headaches AND dizziness, triggered by stress, anxiety and computer screentime.

The strange thing about dizziness, giddiness and vertigo conditions, is that it might be something as harmless and easily treatable like Benign Positional Paroxysmal Vertigo (BPPV), the commonest ear-related vertigo/dizziness condition there is. In BPPV, calcium crystals become loose and fall off to irritate other parts of the inner ear with recurrent attacks of vertigo lasting typically a few seconds. BPPV is certainly easily treatable quite successfully but it needs to be properly diagnosed in order to carry out the correct type of therapeutic manoeuvre. You’re certainly not going to diagnose BPPV using a brain scan because the crystals are just too tiny to be detected. And the answer is definitely NOT longterm medication! For more resistant rare cases of BPPV, surgery may occasionally be indicated to plug off the affected part of the inner ear with the crystal buildup. Even seemingly innocuous unrelated conditions such as nasal allergies and sinus infections, can also cause patients to feel dizzy, so they need to be treated properly.

Sometimes though, it might be something that can really destroy your quality of life such as severe resistant Meniere’s disease where the poor patient suffers recurrent dizzy attacks of spinning vertigo and imbalance, associated with a blocked ear sensation and fluctuating hearing loss. Enlarging cysts of trapped skin growing behind the eardrum, called cholesteatomas, can also erode into the inner ear to cause dizziness, giddiness and imbalance. These cholesteatoma growths need to be surgically removed to prevent further destruction of the precious inner ear structures. Chronic eardrum infections, are also abnormal and may lead to deeper infection of the inner ear to cause vertigo and dizziness.

Ok, so now you know it’s not easy to diagnose and treat a dizzy patient properly but you realise how important it is to reach the correct conclusion to help the dizzy patient feel better. But in the meantime, if you suffer a sudden dizzy attack, what can you do?

Here are Dr Annabelle’s Dizzy Tips:

1. Do NOT Panic if you start to feel dizzy. Instead, take a few deep breaths and go lie down to rest somewhere comfortable, perhaps somewhere without bright lights.
2. Take medications such as Stemetil (prochlorperazine) or cinnarizine if you have previously been prescribed them by your family doctor. They won’t “cure” your underlying condition but they often help to suppress any inner ear irritation signals to help calm down the dizziness. Avoid taking these medications longterm as they can affect your own natural recovery progress.
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 and 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, take 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 of triggers emerges.
5. Stop any computer work or screentime you might be doing as this might be the trigger for your dizziness flare-up.
6. If the dizziness still doesn’t seem to be improving within a few hours, or if there is severe nausea and vomitng, or severe headaches and/or visual blurring, please go and see your friendly ENT specialist in Singapore with an interest in dizziness and balance disorders!

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