Vertigo is a specific type of dizziness characterised by the false sensation that you or your surroundings are spinning or moving when there is no actual movement. Unlike general dizziness or lightheadedness, vertigo involves a distinct rotational component that often comes with nausea, vomiting, and difficulty maintaining balance. This condition results from problems in either the inner ear (peripheral vertigo) or the brain (central vertigo), with the inner ear being responsible for the majority of cases. In Singapore’s environment, vertigo can be challenging as it may affect your ability to commute, work, and maintain your usual lifestyle. The condition affects people of all ages but becomes more common with age.
Vertigo in Singapore
Experiencing the world spinning around you can be unsettling and may impact your daily life. Vertigo, characterised by a false sensation of movement or spinning, is a common condition that can range from mild episodes to attacks that may interfere with work, driving, and normal activities. At our clinic, our ENT Specialist understands the concerns vertigo causes and provides comprehensive evaluation and treatment to help address your balance issues. With modern diagnostic equipment and evidence-based treatment approaches, we aim to identify the cause of your vertigo and provide appropriate management.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Vertigo?
Types of Vertigo
- Peripheral Vertigo: Peripheral vertigo originates from problems in the inner ear or vestibular nerve. This is the most common form of vertigo. The inner ear contains tiny organs that detect head position and movement, sending signals to the brain to maintain balance. When these structures malfunction, they send incorrect signals, resulting in the spinning sensation characteristic of vertigo.
- Central Vertigo: Central vertigo stems from problems in the brain, particularly in the brainstem or cerebellum. Though less common than peripheral vertigo, it can indicate underlying conditions. Central vertigo typically presents with additional neurological symptoms and tends to be less severe but more constant than peripheral vertigo. The episodes often last longer and may not respond to typical vertigo treatments.
- Positional Vertigo: Benign Paroxysmal Positional Vertigo (BPPV) is triggered by specific head movements or positions. This occurs when tiny calcium crystals in the inner ear become dislodged and move into the wrong canal. BPPV is a common cause of vertigo, particularly in older adults, and while episodes are brief, they can be intense.
Causes & Risk Factors
Common Causes
The frequent causes of vertigo include BPPV, where calcium crystals in the inner ear become displaced, affecting balance signals to the brain. Vestibular neuritis, an inflammation of the vestibular nerve often following a viral infection, can cause sudden vertigo. Meniere’s disease involves excess fluid in the inner ear, leading to vertigo episodes along with hearing loss and tinnitus. Labyrinthitis, an inflammation of the inner ear labyrinth, combines vertigo with hearing problems. Migraines can trigger vestibular symptoms, causing vertigo even without headache.
Risk Factors
Age increases vertigo risk, as inner ear structures naturally change over time. A history of head injuries or ear infections may increase the likelihood of developing vertigo. Certain medications, particularly some antibiotics and diuretics, can affect inner ear structures. Cardiovascular conditions affecting blood flow to the brain or inner ear may contribute to vertigo risk. Anxiety and stress can trigger or worsen vertigo episodes. In Singapore’s humid climate, seasonal allergies and sinus problems may also contribute to inner ear pressure changes that could trigger vertigo.
Signs & Symptoms
Mild Symptoms
- Slight unsteadiness when walking or standing
- Brief episodes of spinning
- Mild nausea without vomiting
- Slight difficulty focusing eyes
- Feeling off-balance when turning head quickly
- Mild ear pressure or fullness
- Occasional lightheadedness
Moderate Symptoms
- Room-spinning sensation
- Nausea with occasional vomiting
- Difficulty walking straight
- Need to hold onto objects for support
- Increased symptoms with head movement
- Ringing in ears (tinnitus)
- Temporary hearing changes
- Sweating during episodes
Severe Symptoms
- Intense spinning
- Severe nausea and repeated vomiting
- Inability to stand or walk
- Falls due to loss of balance
- Headaches accompanying vertigo
- Double vision or visual disturbances
- Slurred speech or confusion
- Weakness or numbness in limbs
Vertigo symptoms typically appear suddenly and can be triggered by specific movements, stress, or occur spontaneously. The pattern and duration of symptoms often provide important clues about the underlying cause.
Experiencing these symptoms?
Schedule a consultation with our ENT Specialist for an evaluation and personalised treatment plan.
When to See an ENT Specialist
Seek immediate medical attention if vertigo is accompanied by severe headache, fever, double vision, weakness in arms or legs, difficulty speaking, or loss of consciousness, as these may indicate a serious condition. Schedule a consultation if vertigo episodes occur repeatedly or interfere with daily activities. Professional evaluation is important when vertigo affects your ability to work, drive, or perform routine tasks safely.
During your first consultation, our ENT Specialist will conduct a thorough medical history review, focusing on your symptoms’ nature, triggers, and duration. The examination includes specific tests to evaluate your balance system and determine whether the vertigo originates from your inner ear or elsewhere. Early intervention may help prevent complications and helps identify any underlying conditions requiring treatment. Proper diagnosis leads to targeted treatment approaches.
Diagnosis & Testing Methods
Diagnosis begins with a detailed clinical history and physical examination focusing on your symptoms’ characteristics. Our ENT Specialist performs specific positional tests, including the Dix-Hallpike manoeuvre, which involves moving your head and body through specific positions to trigger and observe vertigo symptoms. The Head Impulse Test evaluates the vestibulo-ocular reflex, checking how well your eyes and inner ear coordinate during head movements.
Videonystagmography (VNG) uses special goggles with cameras to record eye movements, providing information about inner ear function. This test helps differentiate between peripheral and central causes of vertigo. Audiometry testing evaluates hearing function, as many inner ear conditions affecting balance also impact hearing. For certain cases, vestibular evoked myogenic potentials (VEMP) testing assesses specific parts of the inner ear’s balance organs.
When central causes are suspected, MRI scanning provides brain images to rule out tumours, strokes, or multiple sclerosis. CT scans may evaluate bone structures in complex cases. Blood tests check for infections, thyroid problems, or other systemic conditions contributing to vertigo. Most diagnostic procedures are non-invasive and can be completed during your consultation, with results often available immediately.
Treatment Options Overview
Canalith Repositioning Procedures
The Epley manoeuvre and Semont manoeuvre are specialised head and body movements performed by our ENT Specialist to treat BPPV. These procedures guide displaced calcium crystals back to their proper location in the inner ear. The procedure takes about 15 minutes and may provide relief for BPPV sufferers. Individual results and timelines may vary.
Vestibular Rehabilitation Therapy
This specialised form of physiotherapy aims to retrain your brain to compensate for inner ear problems. Exercises include gaze stabilisation, balance training, and habituation exercises that may gradually reduce sensitivity to movement. Our specialist will design a customised programme based on your specific symptoms and functional goals.
Medications for Symptom Management
Anti-vertigo medications like betahistine may help reduce the frequency and severity of vertigo attacks, particularly in Meniere’s disease. Antiemetics can help control nausea and vomiting during acute episodes. Corticosteroids may be prescribed for vestibular neuritis to reduce inflammation. Diuretics may help manage fluid buildup in Meniere’s disease. Our ENT Specialist carefully selects medications based on your specific diagnosis and medical history.
Lifestyle Modifications
Dietary changes, including reducing salt, caffeine, and alcohol intake, may impact vertigo frequency, especially in Meniere’s disease. Stress management techniques may help prevent vertigo triggers. Adequate sleep and regular exercise can support overall vestibular health. Our specialist provides guidance on lifestyle adjustments tailored to your condition and triggers.
Injection Therapy
For severe, medication-resistant Meniere’s disease, intratympanic steroid injections deliver medication directly to the inner ear. This targeted approach reduces systemic side effects while providing symptom management. Gentamicin injections may be considered for severe cases to reduce vestibular function in the affected ear. These procedures are performed in our clinic under local anaesthesia.
Surgical Interventions
Surgery is reserved for severe cases unresponsive to conservative treatment. Endolymphatic sac decompression aims to reduce fluid pressure in Meniere’s disease. Vestibular nerve section disconnects balance signals from the affected ear. Labyrinthectomy removes inner ear balance organs in cases of complete hearing loss. Our ENT Specialist will thoroughly discuss surgical options if conservative treatments prove insufficient.
Every patient’s condition is unique.
Our ENT specialist will assess your specific situation and recommend the most suitable treatment approach for you.
Complications if Left Untreated
Untreated vertigo can lead to quality of life impacts and safety risks. Repeated falls from balance problems may increase fracture risk, particularly in older adults. The concern about vertigo attacks often leads to anxiety and social isolation as patients avoid activities that might trigger symptoms. Some develop secondary depression from the chronic nature of untreated vertigo.
Professional limitations arise when vertigo affects work performance, especially in jobs requiring balance, driving, or operating machinery. Chronic vertigo can cause persistent nausea leading to weight loss and nutritional deficiencies. Some patients develop compensatory movement patterns, using excessive visual dependence or muscle tension to compensate for balance problems, potentially creating neck pain and headaches. Early treatment may help prevent these complications and help maintain normal function and independence.
Prevention
While not all vertigo causes are preventable, several strategies may reduce your risk. Protect your head from injury by wearing appropriate safety equipment during sports and using seat belts. Manage cardiovascular risk factors through regular exercise, healthy diet, and blood pressure control. Stay hydrated, particularly in Singapore’s hot climate, as dehydration can affect inner ear fluid balance.
Treat ear infections promptly to prevent complications affecting the inner ear. Avoid sudden head movements and position changes, rising slowly from lying or sitting positions. Manage allergies and sinus problems that can affect ear pressure. Limit exposure to loud noises that can damage inner ear structures. Regular check-ups with our ENT Specialist help identify and address problems before they progress to chronic vertigo.
For Singaporeans & Singapore Permanent Residents
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
How long does a typical vertigo episode last?
Episode duration varies depending on the underlying cause. BPPV episodes typically last less than one minute but can recur with position changes. Vestibular neuritis may cause vertigo lasting several days, gradually improving over weeks. Meniere’s disease attacks may last 20 minutes to 24 hours. Central vertigo tends to be more constant but less severe. Our ENT Specialist will help identify your vertigo type and expected episode patterns during your consultation.
Can vertigo be managed effectively?
Treatment success depends on the underlying cause. BPPV often responds well to repositioning manoeuvres. Vestibular neuritis typically improves with time and rehabilitation. Meniere’s disease can be effectively managed. Many patients achieve symptom improvement with appropriate treatment. Our ENT Specialist will provide realistic expectations based on your specific diagnosis.
Is vertigo related to hearing loss?
Some vertigo causes involve both balance and hearing, as these functions share anatomical structures in the inner ear. Meniere’s disease typically causes fluctuating hearing loss along with vertigo. Labyrinthitis affects both balance and hearing. Conditions like BPPV and vestibular neuritis usually don’t affect hearing. Our comprehensive evaluation includes hearing tests to determine if your vertigo has an associated hearing component requiring additional treatment.
Can stress trigger vertigo attacks?
Stress can trigger or worsen vertigo episodes in susceptible individuals. Anxiety increases sensitivity to normal body sensations and can trigger vestibular migraine. Stress also affects sleep quality and immune function, potentially triggering vestibular problems. While stress alone rarely causes vertigo, managing stress through relaxation techniques, regular exercise, and adequate sleep may reduce episode frequency and severity.
What activities should I avoid during vertigo treatment?
During active vertigo episodes, avoid driving, operating machinery, climbing ladders, or any activity where sudden dizziness could cause injury. Swimming should be avoided until cleared by our ENT Specialist, as disorientation underwater can be dangerous. Complete inactivity often worsens symptoms. Our specialist will provide specific activity guidelines based on your condition and treatment stage, gradually increasing activities as your symptoms improve.
How effective is the Epley manoeuvre for treating vertigo?
The Epley manoeuvre can be effective for BPPV when performed correctly. Success depends on accurate diagnosis and proper technique execution. Our ENT Specialist ensures correct positioning and may modify the technique based on your specific canal involvement. Some patients learn modified versions to perform at home for recurring symptoms. The manoeuvre is only effective for BPPV and won’t help other vertigo causes.
Will I need to take medication long-term for vertigo?
Medication duration depends on your specific diagnosis and response to treatment. Acute vestibular conditions may only require short-term medication during the initial phase. Meniere’s disease might need longer-term preventive medication. Many patients reduce or discontinue medications as vestibular rehabilitation improves their natural compensation. Our ENT Specialist regularly reviews your medication needs, adjusting treatment as your condition improves.
Can vertigo return after treatment?
Recurrence possibility varies by condition. BPPV may recur but responds well to repeated treatment. Meniere’s disease is typically episodic, requiring ongoing management. Vestibular neuritis rarely recurs in the same ear. Our ENT Specialist will discuss your specific recurrence risk and provide strategies to minimise future episodes, including maintenance exercises and lifestyle modifications.
Conclusion
Living with vertigo can be challenging, but treatment options are available to help address stability concerns. Understanding your specific type of vertigo is important for treatment planning, as different causes require different approaches. Our ENT specialist in Singapore combines modern diagnostic techniques with evidence-based treatments to address your unique situation. From repositioning manoeuvres for BPPV to comprehensive management plans for complex vestibular disorders, we provide personalised care that aims to target the cause of your symptoms. With proper diagnosis and treatment, many patients experience improvement in their vertigo symptoms and can return to their normal activities.
Take the First Step Towards Better Health
Living with vertigo can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating vertigo using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He underwent his subspecialty training in Rhinology (Nose & Sinus conditions) and Endoscopic Skull Base Surgery at the renowned St Paul’s Sinus Center, part of the University of British Columbia in Vancouver, Canada. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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Our Location
A Specialist Clinic for Sinus, Snoring & ENT
38 Irrawaddy Road #08-45
Mount Elizabeth Novena Hospital
Singapore 329563
Mon – Fri: 9:00 am – 5:00 pm
Sat: 8:30 am – 12:00 pm