Benign paroxysmal positional vertigo (BPPV) is caused by the movement of minute calcium carbonate crystals into the semi-circular canals which disrupt normal eye movements causing repetitive jerky eye movements called nystagmus in certain head positions (such as turning over in bed).  Sensations of room spinning, vertigo and nausea usually accompany this although they are shortlived and only last for seconds. Causes of BPPV can occur from a head injury, whiplash or for no reason, often in the elderly. BPPV can be diagnosed by the Hallpike test and usually can be treated with canalith repositioning manoeuvers such as the Epley.

Vestibular migraine can occur with or without a headache and often presents with lightheadedness and intolerance to movement and moving images.  Other symptoms are nausea and vomiting, visual disturbances, difficulty concentrating and sensitivity to noise and light. Common triggers are stress, lack of sleep, certain food and drink, smoking and certain medications.  The cause is unknown but can be triggered by anxiety and depression or other forms of dizziness such as Menieres, which is it often confused with, and they can both co-exist. Treatment is orientated around addressing the causes of the triggers and therefore improving sleep, diet, hydration and reducing stress.

Menieres is a disease characterised by symptoms of vertigo, or spinning sensations, tinnitus, a full or deep pressure feeling in the inner ear, and hearing loss.  These symptoms can last for minutes or hours, and their cause is not fully understood. This is usually treated by medication although vestibular rehabilitation can be effective for any balance problems.

Persistent Postural-Perceptual Dizziness (PPPD) presents as dizziness and swaying or rocking unsteadiness which occurs over 15 days in a 30 day period although most people have symptoms daily.  These symptoms can be aggravated by an upright sitting or standing posture, head or body motion, and exposure to busy moving environments and visual stimuli such as computers, phones, and reading.   They normally follow a peripheral or central vestibular disorder, vestibular migraine, a mild traumatic brain injury (concussion), and other medical conditions causing dizziness or medication induced dizziness.  This can be very debilitating and disruptive to a normal life routine and can lead to stress, anxiety and depression as well as feelings of isolation. Vestibular rehabilitation in conjunction with counselling and some medication can help promote a gradual return to normal function, reducing symptoms and enabling a normal lifestyle.

Acoustic Neuroma (Vestibular Schwanoma) This benign tumour develops on the vestibular (balance) or cochlea (hearing) nerve and causes loss of balance and hearing on the affected side.  This is usually treated surgically and vestibular rehabilitation can help to improve balance and reduce feelings of unsteadiness.

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Dizziness in the Elderly is multifactorial but deterioration of the peripheral vestibular system (inner ear structures), postural stability as well as joint and soft tissue injury/surgery can contribute to poor balance and lead to falls.  Other causes such as certain medication, neurological conditions (stroke), reduced vision and hearing can cause imbalance and an assessment on the balance system will take this into account and treat the problem areas.

Dizziness and loss of balance can be caused by neurological disorders, such as a stroke, multiple schlerosis, head injury, cerebellar conditions (which is a major balance centre in the brain) and epilepsy.  Cardiovascular conditions such as cardiac arrythmias, cerebrovascular conditions, low or high blood pressure can cause dizziness as well as certain medications, loss of hearing and vision as mentioned earlier.  Your assessment will screen for any of these conditions and a referral to an appropriate specialist will be made.

Concussion is a mild blow to the head resulting in symptoms which can include headache, dizziness, nausea or vomiting, memory loss, unusual behaviour such as mood changes, confusion and loss of focus, clumsiness or reduced balance and the urge to fall asleep.  These can last from anything up to a few weeks to a year or longer. Treatment and management includes resting and taking a break from work or any stressful situations, and vestibular rehabilitation is effective in reducing visual disturbances and improving balance.  Psychological support and advice is very important to manage anxiety and stress caused by these symptoms and their longevity.