Vestibular and Balance Disorders:
Specialist Diagnosis & Rehabilitation

This is the classic description of Benign Paroxysmal Positional Vertigo (BPPV) — by far the most common cause of vertigo, affecting approximately 2.4% of adults over a lifetime. BPPV is caused by tiny calcium carbonate crystals (otoconia) from the utricle in the inner ear dislodging and migrating into one of the semicircular canals. When you move your head in the plane of the affected canal, these crystals move and trigger a false signal of rotation, producing the brief spinning sensation. The key features that confirm BPPV: the vertigo is brief (usually 10–30 seconds, always less than a minute); it is triggered by specific head positions (lying down, rolling to one side, looking up); and it is not associated with hearing loss or focal neurological symptoms. A simple diagnostic test called the Dix-Hallpike manoeuvre at KIMS confirms the diagnosis in minutes. The treatment — the Epley repositioning manoeuvre — is performed in the clinic and resolves BPPV in over 90% of patients after 1–3 treatments. Call 040-44885000.

The picture you describe — severe continuous vertigo lasting many hours with vomiting and inability to walk, but without headache and without hearing loss — is most consistent with vestibular neuritis (inflammation of the vestibular nerve), not a stroke. Vestibular neuritis is caused by viral inflammation of the vestibular nerve and produces acute, severe, continuous (not positional) vertigo lasting hours to days. The absence of headache, double vision, slurred speech, limb weakness, or facial asymmetry argues against a posterior fossa stroke. However, the HINTS examination at KIMS (a bedside test of eye movements) is the most important step to distinguish vestibular neuritis (peripheral) from a brainstem or cerebellar stroke (central). If there is ANY suspicion of central pathology, an MRI brain with DWI is performed immediately. At KIMS, the emergency neurology team performs the HINTS exam in all patients with acute vertigo and selects MRI when needed. Call 040-44885000, or 040-46324365 if symptoms are severe.

The symptom cluster you describe — episodic vertigo lasting 20 minutes to 2 hours, with fullness in one ear, tinnitus (roaring sound), and fluctuating hearing loss all occurring together in the same episode — is the classic tetrad of Menière's disease. Menière's is caused by excess endolymph (inner ear fluid) distending the membranous labyrinth — a condition called endolymphatic hydrops. The distension affects both the cochlea (causing hearing loss and tinnitus) and the vestibule (causing vertigo), which is why all four symptoms occur together. Between attacks, the patient often feels completely normal initially, but over years the hearing loss becomes progressively permanent. The diagnosis at KIMS is confirmed by audiometry (low-frequency sensorineural hearing loss) and electrocochleography (ECochG). Treatment begins with dietary salt restriction and diuretics to reduce endolymph pressure. Call 040-44885000.

No — a CT scan is not sufficient to exclude a posterior fossa (brainstem and cerebellum) stroke. CT is very insensitive for acute ischaemic strokes in the posterior fossa — the dense bone of the posterior skull obscures the brainstem and cerebellum on CT, and small infarcts in these critical structures can be invisible on CT even 24–48 hours after onset. MRI with diffusion-weighted imaging (DWI) is the gold standard for detecting acute posterior fossa infarction. A normal DWI in the first 24–48 hours does not completely exclude an acute brainstem infarct (early DWI sensitivity is approximately 80% for acute posterior fossa ischaemia), which is why the clinical examination — particularly the HINTS exam — is critical. The HINTS exam (assessing head impulse, nystagmus direction, and skew deviation) has been shown to be more sensitive than early MRI for posterior fossa stroke in acute vertigo. If the HINTS exam raises concern for a central cause, MRI should be repeated at 48–72 hours even if the first MRI is negative. Call 040-44885000.

Yes, the distinction is the most useful first question in a balance clinic. Vertigo is an illusion of movement — usually spinning — that strongly suggests a vestibular cause (BPPV, vestibular neuritis, Menière's, or central vertigo). Dizziness without spinning is more often non-vestibular: orthostatic hypotension (lightheadedness on standing), POTS (palpitations + lightheadedness on standing), cardiac (rhythm or perfusion problems), or psychogenic. The history and the tilt table or HINTS exam at KIMS sort out which kind.

Yes — direct vestibular and balance-clinic appointments are accepted. Outpatient: 040-44885000 (Mon–Sat). For sudden severe vertigo with headache, double vision, slurred speech, limb weakness, or facial asymmetry, call 040-46324365 immediately — these features can indicate a posterior-fossa stroke.

Initial consultation is 30–60 minutes. The Dix-Hallpike test and Epley manoeuvre for BPPV are usually performed at the same visit. Extended testing (VNG, vHIT, caloric, VEMP, tilt table) is usually scheduled in a single half-day block. A complete diagnostic picture and a rehabilitation plan are typically in place within 1–2 weeks.