The World Spins – And No One Can Tell You Why
Dizziness is one of the most frustrating symptoms a patient can experience – partly because it encompasses so many different sensations. Is the room spinning? Do you feel lightheaded? Unsteady on your feet? About to faint? Each of these points to a different underlying mechanism, and getting the diagnosis right is the key to effective treatment.
At our practice in Zürich Seefeld, I see patients with dizziness frequently. Many have already seen multiple doctors without a clear answer. A systematic approach to understanding exactly what type of dizziness you have – and why – usually provides the clarity that has been missing.
Types of Dizziness
Vertigo: A spinning or rotational sensation, as if the room is moving around you. This typically points to the vestibular system – the inner ear or the brain’s balance centres.
Presyncope: A feeling of nearly fainting – lightheadedness, greying vision, weakness. This usually indicates reduced blood flow to the brain from cardiovascular or autonomic causes.
Disequilibrium: A sense of unsteadiness or imbalance without spinning, often related to neurological, musculoskeletal, or sensory issues.
Non-specific dizziness: A vague feeling of being “off” or “spaced out,” which can relate to anxiety, medication effects, metabolic issues, or sensory processing problems.
Common Causes
Benign Paroxysmal Positional Vertigo (BPPV): The most common cause of vertigo. Tiny calcium crystals (otoliths) become dislodged in the inner ear, triggering brief but intense spinning episodes with head movements. Highly treatable with repositioning manoeuvres.
Orthostatic hypotension: A drop in blood pressure when standing, causing lightheadedness. Common in older adults, those on blood pressure medication, and people with autonomic dysfunction or dehydration.
Iron deficiency and anaemia: Reduced oxygen delivery to the brain causes lightheadedness, particularly with exertion or standing.
Blood sugar dysregulation: Hypoglycaemia causes dizziness, shakiness, and confusion. Reactive hypoglycaemia after meals is a common and underdiagnosed trigger.
Vestibular neuritis: Inflammation of the vestibular nerve, often post-viral, causing prolonged vertigo lasting days to weeks.
Medication side effects: Many medications list dizziness as a side effect, including antihypertensives, sedatives, antidepressants, and anticonvulsants.
Anxiety and hyperventilation: Chronic anxiety can cause persistent dizziness through hyperventilation (respiratory alkalosis), heightened vestibular sensitivity, and autonomic dysregulation.
Cervicogenic dizziness: Neck problems – muscular tension, cervical spine dysfunction – can affect proprioceptive input and cause a sense of imbalance.
Our Diagnostic Approach
I start with a detailed history – the character, duration, triggers, and associated symptoms of your dizziness give crucial diagnostic clues. Physical examination includes the Dix-Hallpike manoeuvre (for BPPV), orthostatic vital signs, neurological assessment, and cervical spine evaluation. Blood work covers haemoglobin, iron, blood sugar, thyroid function, and electrolytes. Further testing (audiometry, vestibular function tests, cardiac evaluation, or MRI) is arranged when indicated.
What We Do: Targeted Treatment
Epley manoeuvre for BPPV: A simple repositioning technique performed in the office that resolves most cases of BPPV within one to two sessions.
Correct underlying deficiencies: Iron, vitamin B12, and blood sugar stabilisation can resolve dizziness that has persisted for months.
Medication review: Adjusting or changing medications that may be contributing to dizziness.
Vestibular rehabilitation: For persistent vestibular dysfunction, specialised physiotherapy exercises retrain the balance system.
Autonomic support: For orthostatic issues, hydration strategies, compression garments, and graded exercise can improve tolerance.
Conclusion
Dizziness is a symptom, not a diagnosis – and there is almost always an identifiable cause. If you have been living with unexplained dizziness, a systematic evaluation at our practice in Zürich Seefeld can provide the answers you have been looking for.
