Most ear-related dizziness seen in the GP surgery is due to BPPV or Méniere’s disease. New treatments make these conditions easier to manage either by a GP, or by an ENT specialist. Mr Paul Montgomery – Consultant Ear, Nose & Throat Surgeon at 150 Harley Street explains more about these two ear conditions.


Benign Paroxysmal Positional Vertigo (BPPV), is the most common cause of vertigo.

With this condition, specific changes in the position of your head can cause the sensation that you, your head, or your surroundings are spinning around. It typically lasts for up to 20 seconds and can be very frightening and disorientating, particularly if you are alone or in a place where there is risk of greater damage to yourself or others, like when driving, or if there is a risk of falling.

Everyday movements such as bending over, turning in bed, looking upwards, or driving can result in bringing on this dizziness, which can also lead to feeling sick and unsteady often for many hours after the initial attack. It can also lead to vomiting.

If untreated, attacks can go on for a couple of months or more, and in some cases years.

Causes and treatment of BPPV

BPPV is caused by dislodged crystals in the inner ear, which can hit balance-sensing areas, also in the inner ear, and result in this feeling of the world spinning around. These crystals may have been dislodged by a head injury, a recent viral infection or simply by the ageing process.

Although patients can help themselves by avoiding any movements of the head that cause the dizziness, it is best to seek medical guidance, for two reasons:

(1) Having a proper assessment is vital, as there are many other important causes of dizziness that need to be ruled out.

(2) If BPPV is diagnosed your doctor can quickly and effectively treat the disorder in their surgery.

Treatment for BPPV is designed to put the crystals back into the correct place and it can be carried out by a simple series of head movements.

  • Epley’s Manoeuvre is used for crystals in the posterior semi-circular canal, or
  • BBQ Manoeuvre is used for crystals in the horizontal semi-circular canal.

These manoeuvres are very safe, over 90% effective and take only 5-10 minutes.

Ménière’s disease

Ménière’s (coincidentally pronounced “many-ears”!) disease is a repeating problem where there is a build-up of fluid in the membranes of the inner ear, which gives a feeling of pressure or fullness in the ears.

These membranes then suddenly burst and when they do it can make you feel very dizzy. This spinning feeling lasts at least 30 minutes but it may continue for several hours. With the dizziness and sickness, hearing levels also drop and patients experience ringing in their ears.

Attacks are unpredictable and may occur many months apart. The long-term effects are a reduction of hearing in one or both ears and a marked reduction in the quality of life during attacks for those badly affected.

The treatment of severe Meniere’s disease has been significantly improved due to research. Injections of steroids behind the eardrum under a local anaesthetic have shown to be safe and effective, with vertigo attacks reduced by 90% following treatment and no harm to the hearing. Increased speech discrimination after treatment was evident too.

For more information about dizziness including causes, diagnosis and effective treatment, contact our team for an appointment.