A practical guide to navigating your consultation — and why describing how dizzy you feel may matter less than you think
All of us have experienced some form of dizziness or vertigo — perhaps after spinning too fast and stopping suddenly, or during a roller coaster ride. Children, in fact, love provoking these sensations deliberately.
However, for many people, vertigo can arrive like a bolt from the blue and turn into a nightmare. Visiting doctor after doctor can leave one feeling that there is no treatment for this condition. To be honest, dizziness is a problem that doctors cannot see, feel, hear, or smell. People with vertigo often look perfectly fine. They struggle to describe their symptoms, and their descriptions are often inconsistent from one visit to the next.
Dizziness is a non-specific term that patients use to describe some form of ill feeling. The range of symptoms that fall under this label is large and includes:
These symptoms can also sometimes point to cardiac disturbances, medication side effects, or even psychological disorders.
Many people report that their symptoms are centred around the head while their walking is normal. For others, the main problem is difficulty walking, while their head feels fine.
People with vertigo often spend a long time without a clear diagnosis, simply trying to understand what is happening to them.
In fact, many patients are simply told by their doctors that they "have vertigo" — as though vertigo itself were a diagnosis. It is not. Vertigo is a symptom, not a diagnosis — much like fever. Just as fever can be caused by dengue, COVID, influenza, typhoid, tuberculosis, or malaria, vertigo is a symptom of an underlying condition, which I will discuss in future articles.
In the past, many doctors determined the nature of a patient's problem based on the quality of the symptom. For example:
This approach is now known to be unreliable — and here is why.
In a landmark study published in Mayo Clinic Proceedings (Newman-Toker et al., 2007), nearly 300 patients presenting to an Emergency Room were asked to identify their symptom from six options:
In a companion study from the same group, patients were asked to choose as many responses as applied to them. 80% chose two types of symptoms, and over 50% chose three. Strikingly, 75% of those who did not select vertigo as their primary symptom actually turned out to have an inner ear problem.
The quality or sensation of your dizziness is not a reliable indicator of its cause. Do not over-emphasise the nature of your sensation when speaking to your doctor.
Because descriptions of dizziness are unreliable, other characteristics are far more important in arriving at a diagnosis. These are:
Try to identify whether your problem is:
The most frequent cause of a single vertigo attack is Vestibular Neuritis — an infection or inflammation of the balance nerve. However, stroke must always be considered. The most common cause of recurrent spontaneous vertigo is Vestibular Migraine. Chronic dizziness can result from neurological conditions or inner ear problems affecting both sides.
You will help your doctor enormously if you summarise the above into a single short paragraph before your visit.
A doctor's time is, unfortunately, limited. In a busy outpatient clinic in India, your physician may have anywhere from 5 to 20 minutes with you. If you spend that time describing only how the dizziness feels, the consultation will feel rushed and unsatisfying — for both of you.
However, if you provide specific information about the type of presentation, duration, triggers, and associated symptoms, your doctor will often have a working diagnosis before you have even finished speaking — and can then spend that valuable time discussing management with you.
For any acute episode, go to the Emergency Room immediately if your vertigo or dizziness is accompanied by any of the following:
A helpful way to remember the warning signs is BE-FAST:
Emergency Room doctors are excellent at ruling out life-threatening conditions such as stroke. However, they are not trained to diagnose and manage non-emergency balance disorders — so a follow-up with the right specialist is still necessary.
There are broadly two types of specialists who manage vertigo and dizziness: neurotologists (ENT surgeons with specialised training in balance disorders) and otoneurologists (neurologists with a focus on inner ear and vestibular conditions).
Since the inner ear is responsible for the majority of vestibular problems, ENT surgeons conventionally see most vertigo patients. However, since the brain and brainstem are where mismatches of balance signals are processed, there is a strong neurological dimension as well.
The reality in India — and indeed worldwide — is that there are very few doctors who specialise in this area. Many ENT surgeons are primarily surgical in their practice and have limited time for balance disorder management. Neurologists, though highly trained, are stretched thin managing conditions like stroke, Parkinson's disease, epilepsy, and meningitis. As a result, many patients are passed between specialities and leave with vague labels like "peripheral vertigo" or "no central cause found."
Your best option is an ENT surgeon or neurologist with a demonstrated special interest in vestibular disorders.
A very good starting point — especially for a first episode — is your General Practitioner or General Medicine doctor. They will assess you as a whole person and evaluate your blood pressure, heart, haemoglobin, lungs, kidneys, thyroid, electrolytes, blood sugar, and liver function. Many cases of dizziness turn out to have a systemic cause that your family doctor can identify and treat effectively.
In future articles, I will discuss the specific conditions that cause vertigo and dizziness — BPPV, Ménière's disease, Vestibular Migraine, and more — and how they are diagnosed and treated.
What to Tell Your Doctor When You Have Vertigo or Dizziness Vestibular Health · An ENT Surgeon’s Guide for Indian Patients Patient Education · Issue
Welcome to Dr. Mukundan Subramanian’s website. He is an experienced ENT, Head & Neck Surgeon with more than 16 years of experience.