The word dizziness can be used to describe a lot of different feelings. Problems with the ear can lead to sensations that either you, or the world around you, are moving, and throwing you off balance. 'Vertigo' tends to mean that the world is spinning around you, and it is caused by imbalance in the function of the balance organs in each ear. 'Dysequilibrium' refers to a feeling of persistent unsteadiness - similar to being on a ship, and it happens when balance function is lost, and you have not yet had time to recover.

Vertigo is one of the most unpleasant feelings to have - studies have shown vertigo affects quality of life much more than symptoms like pain or hearing loss (1). Generally, however, the outlook for conditions that cause vertigo is good.

The causes of vertigo include:

• 'BPPV' (Benign paroxysmal positional vertigo) - this is the most common cause of vertigo -it causes brief periods of vertigo (usually up to a couple of minutes in length), and can be easily treated by performing manoeuvres to 'reset' the balance organ.
• 'Vestibular migraine' (2) - this is another common cause of vertigo. It is sometimes, but not always, associated with getting headaches. It can cause a variety of balance problems. 
• 'Vestibular neuronitis' & 'Labyrinthitis' - these problems cause a sudden loss of the function of the balance organ in one ear. They are differentiated by labyrinthitis also causing hearing loss.
• 'Meniere's disease' - this is an uncommon condition that causes recurrent attacks of vertigo lasting around an hour or two. These attacks are often accompanied by sudden hearing loss, and a feeling of fullness or pressure, in the ear. 
• 'Superior semicircular canal dehisence' - this is a rare condition in which the inner ear has an opening into the skull. It can make you very sensitive to sounds within your body, and also cause balance problems - particularly when there are loud sounds.
  
  

The tests for all of these conditions are slightly different. The most important aspect of assessment is a good description of the dizziness - so please feel free to make notes about how you feel, what you see, and what you are doing during episodes of dizziness. There are a number of things we can do in the clinic to look for causes of dizziness, and how the balance organs are functioning.- although some of these can make you feel dizzy. If this does not give enough information, other tests that are sometimes needed include scans of the ears and head, hearing tests, and various tests giving a detailed assessment of how the balance organ is functioning.

References:

1. Health-related quality of life and functional impairment in acute vestibular disorders. Möhwald K, Hadzhikolev H, Bardins S, Becker-Bense S, Brandt T, Grill E, Jahn K, Dieterich M, Zwergal A. Eur J Neurol. 2020 May 13.

2, Treatment of Vestibular Migraine: A Systematic Review and Meta-analysis. Byun YJ, Levy DA, Nguyen SA, Brennan E, Rizk HG. Laryngoscope. 2020 Feb 21.