Repositioning manoeuvres
For positional vertigo (BPPV), a sequence of head movements done in the clinic, such as the Epley manoeuvre, often settles symptoms in one or two sessions.
DIZZINESS & BALANCE · ISLAMABAD
Dizziness, vertigo & balanceassessment and next steps.
Dr M Riaz Khokhar assesses recurring dizziness and spinning sensations, identifies inner ear causes that can be treated, and refers you to the right specialist when the cause lies elsewhere, at PNS Hafeez Hospital Islamabad.
Evening clinic, Monday to Friday, 5–7 pm. Your appointment time will be confirmed by the clinic.
WHEN TO COME
Reasons to have dizziness assessed.
- A spinning sensation when you turn over in bed, look up or bend down.
- Attacks of vertigo lasting minutes to hours, with nausea or vomiting.
- Dizziness together with hearing loss, tinnitus or a feeling of fullness in the ear.
- Unsteadiness that has continued after an ear infection or a viral illness.
- Dizziness that keeps returning and affects work, driving or confidence in walking.
- Repeated falls or a fear of falling.
Dizziness has many causes, and not all of them come from the ear. Blood pressure, the heart, medicines, anaemia and the nervous system can also be responsible. The first task is to work out which.
YOUR VISIT
What happens at a dizziness consultation.
Your description is the most useful part of the assessment. Note when attacks happen, how long they last and what sets them off, and bring a list of your medicines.
1
A detailed history
What the dizziness feels like, how long it lasts, what triggers it, and any hearing symptoms, headaches or other medical conditions.
2
Examination
Ears, eye movements, balance and walking are examined, along with basic checks of the nerves.
3
Positional testing
You are moved from sitting to lying with the head turned (the Dix-Hallpike test) to look for the commonest inner ear cause of vertigo.
4
Hearing test
A hearing test is often arranged because the hearing and balance organs lie together in the inner ear.
5
Scans or referral when needed
An MRI scan, blood tests or referral to a neurologist or physician is arranged when the findings point away from the ear.
6
A clear plan
You will be told the likely cause, what can be done about it, and who is the right person to manage it.
TREATMENT OPTIONS
Treatment depends on the cause.
Medicines
Short courses for severe attacks, and preventive treatment for conditions such as Ménière's disease or vestibular migraine. Long-term use of dizziness tablets is usually avoided because it slows recovery.
Balance exercises
Vestibular rehabilitation exercises retrain the balance system and are the main treatment for lasting unsteadiness.
COMMON CAUSES
Inner ear conditions that cause dizziness.
Positional vertigo (BPPV)
Brief spinning lasting under a minute, set off by head movements. It is the commonest cause of vertigo and is usually treated in the clinic without medicines.
Vestibular neuritis
Sudden, severe vertigo lasting days, usually after a viral illness. It improves over weeks, and balance exercises speed recovery.
Ménière's disease
Attacks of vertigo lasting hours, with hearing loss, tinnitus and fullness in one ear. It is managed with diet, medicines and, in some cases, further treatment.
Vestibular migraine
Dizziness linked to migraine, sometimes without a headache. It is treated in the same way as migraine, often together with a neurologist.
When to seek urgent care
Go to the nearest emergency department if you have:
- Dizziness with weakness or numbness of the face, arm or leg, slurred speech or double vision.
- Dizziness with a sudden severe headache, chest pain or fainting.
- Being unable to stand or walk without support.
- Vertigo with sudden hearing loss in one ear.
COMMON QUESTIONS
Questions patients often ask.
Is dizziness always an ear problem?
No. The inner ear is one common cause, but blood pressure, heart rhythm, medicines, anaemia, anxiety and neurological conditions also cause dizziness. Assessment aims to find which applies to you.
What is the difference between dizziness and vertigo?
Dizziness is a general word for feeling light-headed, faint or unsteady. Vertigo is the specific feeling that you or the room are spinning, and it more often points to the inner ear.
Do neck (cervical) problems cause vertigo?
Neck problems are often blamed, but they are an uncommon cause of true spinning vertigo. An inner ear cause such as BPPV is far more likely and is easy to check for.
Should I keep taking tablets for dizziness?
Tablets help during a severe attack, but taking them for weeks or months can delay the brain's natural recovery of balance. Do not stop a prescribed medicine without asking your doctor.
Will the dizziness come back?
It depends on the cause. BPPV can return and is treated in the same way each time. Many other causes settle fully.
What should I bring to my appointment?
A list of all your medicines, previous hearing tests, any brain or ear scans, and notes on when your attacks happen. If possible, come with someone, as testing can briefly bring on dizziness.
Reviewed by Dr M Riaz Khokhar, ENT Consultant · November 2026. This page gives general information and does not replace a consultation.
Ready to arrange a dizziness consultation?
Monday–Friday · 5–7 pm · PNS Hafeez Hospital Islamabad