Why You Feel Dizzy: Vertigo Causes, Diagnosis & Treatment

Chakkar aate hain — kya ye vertigo hai?

"Doctor, mujhe chakkar aa rahe hain." Nearly every dizziness consultation in my OPD opens with that sentence. When I ask what the feeling is actually like, the answers split into three groups. Some describe the room turning like a ceiling fan. Some feel light in the head, as though they may faint. Others feel unsteady, as if walking on a moving boat. Only the first group has true vertigo. Vertigo is the illusion that you, or the world around you, is rotating when nothing is moving at all. Chakkar is the umbrella word; vertigo is one specific shape underneath it.

Balance trouble is commoner than most people assume. The US National Institute on Deafness and Other Communication Disorders reports that about 15 percent of American adults — 33 million people — had a balance or dizziness problem in a single year. The NHS puts the sensation plainly: "Vertigo feels like you or everything around you is spinning – enough to affect your balance." That is the description I need from you, in your own words, before I touch any instrument.

Vertigo vs dizziness — what is the difference?

Vertigo and dizziness get used as the same word at the chemist counter, but they are not the same thing. Dizziness is a broad complaint covering at least three separate problems. Presyncope is the near-fainting feeling, usually from blood pressure, sugar or dehydration. Disequilibrium is unsteadiness on the feet, often from joints, eyesight or leg nerves. Vertigo is the spinning illusion, and it points at the balance organ in the inner ear or at the brain. Sorting this out in the first five minutes saves weeks of wrong tests.

What causes vertigo?

The vast majority of vertigo starts in the inner ear, which we call peripheral vertigo. A minority starts in the brain or brainstem — central vertigo — and that group needs faster action. A StatPearls review on the US National Library of Medicine's Bookshelf puts the split at approximately 80% peripheral and approximately 20% central in origin. That ratio is the reason I am usually optimistic when a patient sits down. Most of what walks into an ENT clinic as spinning is fixable. Below are the four causes I see most.

BPPV — benign paroxysmal positional vertigo

Tiny calcium carbonate crystals, called otoconia, sit normally in one part of the inner ear. Sometimes they come loose and drift into a semicircular canal, the fluid-filled tube that senses head rotation. Once they land in the wrong canal, every change of head position sends a false movement signal to the brain, and the room appears to spin. Episodes are short and set off by particular movements — turning in bed, looking up at a shelf, bending to tie a shoe. The StatPearls BPPV review records a reported lifetime prevalence of 2.4% and a 1-year prevalence of 1.6%. That same review calls BPPV "the most frequent cause of peripheral vertigo, accounting for more than half of all cases". It notes that an episode typically lasts 30 to 60 seconds, and begins most often in the fifth to seventh decades of life.

Meniere's disease

Meniere's disease involves excess fluid pressure inside the inner ear, and attacks last far longer than in BPPV. The StatPearls Meniere disease review describes it as "a disorder of the inner ear characterized by hearing loss, tinnitus, and vertigo", with definite attacks lasting 20 minutes to 12 hours. Patients usually report fullness in one ear and hearing that fluctuates. Untreated over years, the hearing loss can become permanent.

Vestibular neuritis and labyrinthitis

A viral inflammation of the balance nerve causes sudden, severe, continuous vertigo, often bad enough to keep someone in bed for two or three days. Labyrinthitis is the same process with hearing involved as well. Both frequently follow a cold or a throat infection. Recovery is gradual, because the brain has to relearn balance from an unequal pair of ears.

Central vertigo

Vertigo coming from the brain or brainstem is less common and more serious. Causes include a mini-stroke, a cerebellar stroke, multiple sclerosis or a tumour. Central vertigo tends to be constant rather than in short bursts, often has no positional trigger, and brings other neurological signs with it.

Kya ye stroke ho sakta hai? — vertigo that cannot wait

Stroke is the one diagnosis I will not let anybody sit on at home, and a small number of vertigo patients are actually having one. What separates them is the company the vertigo keeps. Spinning on its own, triggered by turning in bed, settling in under a minute, is almost never a stroke. Spinning that arrives with new neurological symptoms is a different matter. Do not wait for an OPD slot if any of the following appear alongside the vertigo — go straight to a hospital emergency department.

• A sudden, severe headache unlike any you have had before
• Double vision or a sudden change in eyesight
• Difficulty speaking, slurred speech, or trouble understanding what is said
• Weakness or numbness of the face, arm or leg, particularly on one side
• Inability to walk at all, or a sudden loss of coordination
• Chest pain, palpitations, or a high fever with a stiff neck

"Spinning that starts when you turn in bed and settles in under a minute is almost always the inner ear, and we can often correct it in the clinic with a few guided head movements. But vertigo that arrives with double vision, slurred speech or one-sided weakness is a brain emergency — go straight to a hospital, not an OPD queue." — Dr. Soumya S. Maurya, MBBS, MS (ENT)

How is vertigo diagnosed in Indore?

Diagnosis here rests on the history and the bedside examination, not on a scan ordered before anyone has looked at you. I want to know how long an episode lasts, what sets it off, whether hearing has changed, and whether there is ringing or fullness in one ear. Those four answers narrow the field before I stand up. Then comes the examination: eyes, ears, cranial nerves, gait, and positional tests. Investigations are added only where they change the plan.

The Dix-Hallpike test

The Dix-Hallpike test is the bedside standard for BPPV. You are moved briskly from sitting to lying with the head turned to one side, and I watch your eyes. If crystals are loose, a characteristic flicker — nystagmus — appears within seconds, and its direction tells me which canal is involved. The StatPearls Dix-Hallpike review reports the test's sensitivity for posterior canal BPPV as ranging from 48% to 88%. That is why a negative test with a convincing history gets repeated, not dismissed.

Hearing tests and imaging

A pure-tone audiogram tells me whether hearing is involved, which separates Meniere's disease and labyrinthitis from BPPV. An MRI of the brain and inner ear is reserved for suspected central causes, unexplained one-sided hearing loss, or a patient who has not responded to correct treatment. Most people with positional vertigo never need one.

Does the Epley manoeuvre really work?

The Epley manoeuvre is a sequence of slow, deliberate head and body positions that walks the loose crystals out of the canal and back into the chamber where they belong. No sedation, no admission, no cutting. A Cochrane review summarised in the StatPearls Epley manoeuvre article found a significant likelihood of symptom resolution against a sham manoeuvre, with a number needed to treat of 3. Three patients treated for one extra person cured is, in medicine, a very strong result. Most patients I treat for posterior canal BPPV are substantially better before they leave the room, and a second session settles many of the rest.

Left alone, BPPV does often fade, but slowly. The StatPearls BPPV review notes that one-third of patients achieve remission by 3 weeks, with the majority reaching remission at 6 months. Weeks of being afraid to turn over in bed is a poor trade when a ten-minute manoeuvre exists. Recurrence is real — the same review reports an annual recurrence rate of 15% in one study — so I teach patients the pattern and ask them to come back early.

What else we use — rehabilitation, medicines and surgery

Beyond the repositioning manoeuvre, three tools cover almost everything I see. Vestibular rehabilitation therapy is a graded exercise programme — gaze stabilisation, balance work, controlled head movement — that trains the brain to compensate for an inner ear no longer sending matched signals. Consistency matters more than intensity. Patients who do the exercises daily improve far more than those who do them when they remember.

Vestibular suppressants and anti-sickness medicines help in the first day or two of a severe attack, when a patient cannot keep water down. Taken for weeks, they slow the brain's own compensation. For Meniere's disease, salt restriction and fluid management reduce attack frequency for many patients. Surgery is genuinely a last resort: the StatPearls BPPV review notes that fewer than 1% of BPPV cases need surgical intervention.

Ghar pe abhi kya karein

While the cause is being sorted out, a few simple changes make daily life safer and reduce attacks. None of these replace an examination, and none need anything from a chemist. Sit at the edge of the bed for half a minute before standing, keep a light on in the passage at night, and stop treating the spinning as something to push through. Most vertigo injuries I see are not from the vertigo — they are from the fall.

• Move slowly getting up from bed or a chair. Turn in stages, not one sweep.
• Keep the bedroom and bathroom well lit at night, and use a grab rail if one is available.
• Do not drive, ride a two-wheeler, climb a ladder or work at a height while episodes are active.
• Drink water regularly through the day; dehydration makes every vestibular symptom worse.
• Cut back on caffeine, alcohol and salt if you have been told you have Meniere's disease.
• For headache or discomfort, paracetamol as your doctor has advised. Apne mann se koi aur dawa na lein.

Vertigo ka ilaaj Indore mein — milne kab aana hai

Come in when the spinning has happened more than once, when it stops you doing something you normally do, or when any red flag above is present. Bring three answers with you: how long a typical episode lasts, what position sets it off, and whether your hearing has changed. If you can, avoid a vestibular suppressant on the morning of the appointment — it masks the eye signs I need to see. Positional vertigo is one of the few conditions where you walk in unwell and walk out better.

You can message the clinic on WhatsApp describing your episodes, call D.R. Healthcare on 7869709075 between 6 and 8 PM, or look through our ENT services first. If your dizziness comes with a blocked nose and facial pressure, my note on sinusitis and nasal allergy is worth reading. If it began after cleaning your ears, read why cotton buds cause more trouble than they fix. And before repeating an old prescription for chakkar, please read what self-medication actually costs.

Questions patients ask us