Dizziness & Vertigo Treatment in Singapore

Dizziness vs Vertigo — What's the Difference?

Patients in Singapore often use "giddy", "dizzy", and "vertigo" to mean the same thing, but the distinction matters because it points to very different causes and treatments.

• Dizziness is a general feeling of being unwell — light-headed, woozy, or unsteady. It can come from low blood pressure, dehydration, anaemia, anxiety, or medication side effects.
• Vertigo is the false sensation that you or the room is spinning, tilting, or moving. True vertigo almost always points to a problem in the inner ear (vestibular system) or, less commonly, the brain.
• Imbalance (disequilibrium) is feeling unsteady on your feet without spinning — common in older adults and patients with chronic ear or neurological conditions.

An ENT specialist's first job is to sort which of these you actually have. Dr Pang uses a structured bedside assessment — including the Dix-Hallpike test, head-impulse test, and HINTS examination — to localise the problem within minutes.

Common Causes of Vertigo

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is by far the most common cause of true vertigo we see in clinic. Tiny calcium crystals (otoconia) become dislodged from the utricle and float into one of the semicircular canals. Every time you change head position — rolling over in bed, looking up at a high shelf, lying down at the dentist — the crystals shift and trigger a brief but intense spinning sensation lasting 10 to 60 seconds.

BPPV is dramatic but reassuring: it has nothing to do with the brain, does not damage hearing, and can almost always be cured in a single visit using the Epley manoeuvre.

Ménière's Disease

Ménière's disease is caused by a build-up of fluid (endolymph) in the inner ear. Episodes are characterised by the classic triad of vertigo lasting 20 minutes to several hours, fluctuating hearing loss, and tinnitus — often with a sensation of fullness or pressure in the affected ear. Episodes can occur in clusters, separated by months of remission. Long-term it can cause permanent hearing loss in the affected ear.

Vestibular Neuritis & Labyrinthitis

These are inflammatory conditions, usually triggered by a viral infection. Vestibular neuritis causes sudden, severe, continuous vertigo lasting days, with nausea and unsteadiness but no hearing change. Labyrinthitis is the same picture but with hearing loss as well, because the cochlea is involved. Both usually settle over weeks with vestibular rehabilitation; a short course of steroids may speed recovery if started early.

Vestibular Migraine

Increasingly recognised in Singapore, vestibular migraine causes recurrent vertigo lasting minutes to hours, sometimes with — but often without — a headache. Patients are typically migraine sufferers with a family history. Treatment focuses on identifying triggers (poor sleep, irregular meals, certain foods, stress) and migraine-preventive medication.

Other Causes

• Acoustic neuroma — a benign tumour on the balance nerve. Rare but important to exclude in any patient with one-sided hearing loss or asymmetric tinnitus, which is why MRI is sometimes ordered.
• Persistent Postural-Perceptual Dizziness (PPPD) — a chronic dizziness syndrome that often follows an episode of true vertigo, with a strong overlay of anxiety and visual sensitivity.
• Cervicogenic dizziness — from neck-joint and muscle dysfunction, often after whiplash.

How is Vertigo Diagnosed?

A vertigo assessment with Dr Pang at Mt Elizabeth is structured to reach a working diagnosis within a single visit:

• Detailed history — duration of episodes (seconds, minutes, hours, days), positional triggers, hearing change, tinnitus, ear fullness, headache pattern
• Dix-Hallpike test — the bedside test that confirms posterior canal BPPV, taking under a minute
• Head-impulse test and HINTS exam — bedside tests that distinguish a peripheral (inner ear) problem from a central (brain) problem
• Otoscopy and tympanometry — to exclude middle-ear disease
• Pure-tone audiometry — every vertigo patient gets a hearing test, since hearing loss patterns are diagnostic for Ménière's, labyrinthitis, and acoustic neuroma
• Videonystagmography (VNG) — measures eye movements to map vestibular function in detail; ordered for atypical or recurrent cases
• MRI of the internal auditory meatus — to exclude acoustic neuroma when hearing loss is one-sided or vertigo does not fit a typical pattern

Treatment Options for Vertigo in Singapore

The Epley Manoeuvre for BPPV

If the Dix-Hallpike test confirms posterior canal BPPV, Dr Pang performs the Epley manoeuvre at the same appointment. The manoeuvre is a sequence of head and body positions that uses gravity to roll the displaced crystals back into the utricle, where they no longer trigger vertigo. It takes 3 to 5 minutes and around 80% of patients are cured after a single session; a small minority need a second session a week later.

Vestibular Rehabilitation Therapy

Vestibular rehabilitation is a structured exercise programme that retrains the brain to compensate for inner-ear dysfunction. It is the mainstay of recovery for vestibular neuritis and labyrinthitis, and an important add-on for chronic dizziness, PPPD, and post-surgical patients. We work with experienced vestibular physiotherapists in Singapore for a coordinated rehab plan.

Medication

• Betahistine — first-line maintenance medication for Ménière's disease, taken daily to reduce the frequency and severity of episodes
• Vestibular suppressants (prochlorperazine, cinnarizine) — for short-term symptom relief during an acute attack only; not for long-term use, as they slow vestibular compensation
• Diuretics and low-salt diet — adjuncts in Ménière's management
• Migraine-preventive therapy — for confirmed vestibular migraine

Procedures and Surgery

For Ménière's patients who fail medication, options include intratympanic steroid injection (an in-clinic procedure), intratympanic gentamicin, or surgical decompression. These are reserved for a minority of severe cases.

Why Choose Dr Pang for Vertigo Treatment?

• Over 20 years of senior ENT practice in the United Kingdom, United States, and Singapore — including former Senior Consultant and Clinical Director at the National University Hospital ENT Department
• Structured vestibular assessment in a single appointment — Dix-Hallpike, head-impulse, hearing test, and Epley manoeuvre all performed in clinic
• Direct access to MRI and audiology at Mt Elizabeth Medical Centre when further imaging is needed
• Coordinated care with experienced Singapore vestibular physiotherapists
• Same-week appointments for acute vertigo

Frequently Asked Questions