Vertigo is not a diagnosis. It describes a sensation, and the sensation you describe is the strongest single clue to what is causing it. Getting that description right is what turns a vague complaint into a treatable problem.
Giddiness, dizziness, and vertigo describe different sensations
Doctors separate these words even when patients use them interchangeably. Vertigo means a sense of motion when nothing is actually moving, usually spinning, either of you or of the room around you. Giddiness and lightheadedness describe feeling faint or woozy without that rotational element.1 Unsteadiness is different again. You feel fine sitting down, then your balance goes when you stand or walk.
A specialist will try to pin this down early, sometimes by asking whether it feels like the room is spinning around you or whether you feel like the one spinning.1 Each pattern points at a different part of the body. True spinning usually points to the inner ear balance organ or the nerve serving it. Feeling faint points more often at blood pressure, heart rhythm, or medication. Unsteadiness without spinning can come from the nerves in your legs, your joints, or your vision.
You cannot settle this at home. What you can do is arrive with a clear description rather than the single word “giddy”, which sends the assessment back to the start.
What causes vertigo and giddiness?
The inner ear is behind most cases, and the most common cause is benign paroxysmal positional vertigo, usually shortened to BPPV. Tiny calcium carbonate crystals that belong elsewhere in the ear come loose and settle in one of the semicircular canals. When you move your head, the crystals move too, and the canal reports a rotation that is not happening. Episodes are brief, often under a minute, and triggered fairly reliably by lying down, sitting up, turning over in bed, or looking up.1,2
Age changes the picture. Dr Chan Yew Meng, a senior consultant in otolaryngology at Singapore General Hospital, has described BPPV as the most common cause of dizziness in older adults and a risk factor for falls.7 Greater awareness and an ageing population have both pushed up the number of people here seeking help for balance problems.7
Vestibular neuritis and labyrinthitis come next. Both involve inflammation of the balance nerve or the inner ear itself, often following a viral infection. The vertigo is severe and constant rather than positional, and it lasts days rather than seconds. Labyrinthitis tends to affect hearing as well; vestibular neuritis usually leaves it alone.1
Ménière’s disease is less common and runs to a distinctive pattern: attacks lasting minutes to hours, with hearing loss, ringing in the ear, and a sense of fullness on the affected side.1,8
Vestibular migraine is the one most often missed, because the headache is not always present when the vertigo is. Dr Ho Eu Chin, a consultant at Tan Tock Seng Hospital, has described vestibular migraine and BPPV as the two conditions behind most recurrent vertigo attacks.7 Common triggers include short sleep, stress, and dietary ones such as salt, MSG, caffeine, chocolate, cheese, and alcohol.7 Worth knowing if you eat out most days.
Plenty of giddiness has nothing to do with the ear at all. Standing up too quickly, heart rhythm problems, low blood sugar, anaemia, dehydration, anxiety, and the side effects of common medications including some anticonvulsants and salicylates such as aspirin all produce it.1
| What the episode feels like | How long it lasts | What it often points to |
|---|---|---|
| Spinning triggered by a change in head position | Seconds to about a minute | BPPV |
| Constant severe spinning with no positional trigger | Days | Vestibular neuritis or labyrinthitis |
| Spinning with hearing loss, ringing, and ear fullness | Minutes to hours | Ménière’s disease |
| Spinning or motion sensitivity, often with headache or light sensitivity | Minutes to hours | Vestibular migraine |
| Faint or woozy on standing up | Seconds | Blood pressure or medication |
Treat that as a rough guide rather than a diagnostic tool. The patterns overlap, and one person can have two causes running at once.
When should you see a doctor about vertigo?
See a doctor if giddiness keeps returning, lasts more than a few days, or arrives with hearing loss, ringing, or ear fullness. Go to A&E instead if it comes with double vision, slurred speech, difficulty swallowing, facial droop, or new weakness or numbness.1 A single brief spell that settles on its own is usually less concerning.
Beyond that, the practical test is what the symptom is costing you. Book an assessment if giddiness has stopped you driving, made stairs feel risky, interrupted work, or caused a fall. Vertigo attacks that are not well controlled are a reason not to drive at all, since an attack behind the wheel puts other people at risk too.7
One more reason to get assessed rather than self-treating: the repositioning manoeuvres for BPPV are widely available online, and performing the wrong one can shift the crystals into a different semicircular canal. The result is persisting vertigo and an assessment that now has to untangle two problems instead of one.7 Which canal is affected has to be identified first, and that is what the positional testing in a consultation is for.
There is also a reason not to sit on it with motion sickness tablets. The medicines that suppress vertigo symptoms are meant for short courses during an acute attack. Taken for weeks, they appear to slow the brain’s own compensation, so the balance system takes longer to recalibrate than it otherwise would.1 Most peripheral causes settle well once identified, and moving about early helps that process rather than hindering it.1 Waiting out a mild episode quietly is reasonable, but a recurring one needs a cause rather than a longer course of tablets.
Symptoms that need urgent attention
A small number of presentations need same-day care rather than an appointment.
- Double vision, slurred speech, difficulty swallowing, facial droop, or new numbness or weakness
- Severe unsteadiness where you cannot walk without support
- A sudden drop in hearing in one ear, with or without vertigo
- The worst headache you have had, alongside the giddiness
The first two raise the possibility of a stroke affecting the cerebellum or brainstem, which shares its blood supply with the inner ear.1,3 That is why the two can present so similarly. Their absence does not completely rule out a central cause, but their presence is a clear signal to be seen urgently.1,6
Sudden hearing loss in one ear is the item most often left too late. It is treated as an ENT emergency because the window for treatment is measured in days, not weeks, and hearing that is not treated early may not come back.5 The emergency signs of sudden hearing loss are worth knowing before you need them.
What an ENT assessment for dizziness involves
The history does most of the work. A specialist will ask when the episodes started, how long each one lasts, what brings them on, what position you are in, and what else happens at the same time. Duration alone narrows the field considerably: seconds point one way, hours another, days another again. Imaging and medication get used unnecessarily when this part is rushed, which is why the questions can feel repetitive.1
The examination follows. Your ears are checked, then your eye movements, because involuntary eye movement patterns differ between inner ear causes and central ones. A head impulse test looks at the reflex that holds your gaze steady when your head turns. If BPPV is suspected, the Dix-Hallpike manoeuvre involves lying back quickly from sitting with your head turned to one side, which provokes the vertigo briefly so it can be observed. Balance and walking are assessed too.1,4
Hearing tests are usually included, since a one-sided hearing loss changes the direction of the assessment.1
Formal vestibular testing is arranged when the examination leaves questions open. Novena ENT runs videonystagmography, video head impulse testing, electrocochleography, and vestibular evoked myogenic potential testing in its hearing health facility, and the giddiness and vertigo page sets out what each one measures.
Scans are not routine. Current consensus guidance advises against imaging for patients who meet the criteria for BPPV, unless something in the examination suggests another cause.1,4
Preparing for your appointment
The assessment is only as good as the history you can give, and vertigo is hard to recall accurately once an attack has passed. A week of notes is worth more than trying to remember in the consultation room.
Write down, for each episode: the time of day, what you were doing when it started, how long the sensation lasted, and whether it was spinning or faintness. Note anything that reliably sets it off, particularly head positions. Record any hearing change, ringing, or ear fullness, and which ear.
Bring your full medication list, including supplements and anything bought over the counter, because a fair number of drugs affect the balance system.
If your attacks have been severe, arrange for someone to come with you and do not drive yourself to the appointment.
If giddiness has been recurring, or if it arrived alongside a change in your hearing, an ENT assessment can establish which part of the balance system is involved and what is driving it.
REFERENCES
- Dy JS, Freeman AM. “Vertigo in Clinical Practice: Evidence-Based Diagnosis and Treatment.” StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; updated 12 September 2025. PMID: 29493978. https://www.ncbi.nlm.nih.gov/books/NBK482356/
- Koshi EJ, Sutton AE. “Benign Paroxysmal Positional Vertigo.” StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; updated 30 November 2025. https://www.ncbi.nlm.nih.gov/books/NBK470308/
- Dougherty JM, Carney M, Hohman MH, Emmady PD. “Vestibular Dysfunction.” StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; updated 4 July 2023. https://www.ncbi.nlm.nih.gov/books/NBK558926/
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).” Otolaryngology–Head and Neck Surgery. 2017;156(3_suppl):S1–S47. PMID: 28248609.
- Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. “Clinical Practice Guideline: Sudden Hearing Loss (Update).” Otolaryngology–Head and Neck Surgery. 2019;161(1_suppl):S1–S45. doi:10.1177/0194599819859885
- Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. “HINTS to diagnose stroke in the acute vestibular syndrome.” Stroke. 2009;40(11):3504–3510. PMID: 19762709.
- SingHealth / HealthXchange. “SGH Doctors on Vertigo.” Commentary from Dr Chan Yew Meng (Department of Otolaryngology, Singapore General Hospital) and Dr Ho Eu Chin (Department of Otorhinolaryngology, Tan Tock Seng Hospital). https://www.healthxchange.sg/news/sgh-doctors-vertigo
- SingHealth. “Meniere’s Disease.” Patient information, symptoms and treatments. https://www.singhealth.com.sg/symptoms-treatments/menieres-disease
