ENT Causes of Vertigo and Dizziness

Feeling dizzy or off balance can be unsettling, and when this dizziness is accompanied by a sensation that the room is spinning (known as vertigo), it can interfere with daily life. Many people don’t realise that the ears — not just the brain or heart — play a vital role in keeping us balanced. That’s why ENT (Ear, Nose and Throat) specialists are often the right people to consult when investigating dizziness.

Mr James Ramsden, Consultant ENT Surgeon and Otologist in Oxford, has extensive experience diagnosing and treating patients with balance disorders. Through his work at The Manor Hospital, Oxford University Hospitals and at www.oxfordhearingandbalance.com, he provides comprehensive care to help patients understand the cause of their symptoms and regain stability in their lives.  Mr Ramsden works closely with vestibular physiotherapists to strengthen and improve balance.

Inside your inner ear is a system called the vestibular system, which includes three semicircular canals and two small organs (the saccule and utricle). These structures send signals to your brain about movement, head position and spatial orientation.

If any part of this system is not working properly, it can result in symptoms like:

• Spinning sensation (vertigo)
• Unsteadiness
• Nausea or vomiting
• Blurred vision with head movement
• Feeling ‘foggy’ or disoriented

1. Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is one of the most common causes of vertigo and results from tiny calcium crystals becoming dislodged within the semicircular canals of the inner ear. It typically causes short, intense episodes of spinning triggered by head movement — such as rolling over in bed or looking up.

The good news is that BPPV can often be treated with simple head manoeuvres (such as the Epley manoeuvre) performed in clinic.

2. Labyrinthitis and Vestibular Neuritis
These are caused by viral infections affecting the inner ear. Vestibular neuritis affects the balance nerve (without affecting hearing), while labyrinthitis affects both balance and hearing. Symptoms often include sudden, severe vertigo, imbalance and nausea. Treatment usually involves rest, medications to ease symptoms, and vestibular rehabilitation therapy if needed.

3. Meniere’s Disease
This is a long-term inner ear condition that causes episodes of vertigo, hearing loss, tinnitus (ringing in the ear), and a sensation of fullness in the ear. The cause is linked to fluid imbalance in the inner ear. Meniere’s can be challenging to diagnose early, but careful assessment and symptom tracking help.

4. Vestibular Migraine
Some people experience vertigo as part of a migraine disorder — even if they don’t have a typical headache. Vestibular migraine can cause dizziness lasting minutes to hours, and may include light sensitivity or visual disturbances. Diagnosis requires careful evaluation of symptom patterns.

5. Superior Canal Dehiscence Syndrome (SCDS)
This rare condition involves a tiny opening in one of the semicircular canals. It can cause vertigo triggered by sound or pressure changes, and may be associated with hearing odd internal noises (like your own eyes moving). It requires specialist assessment and often a CT scan for diagnosis.

Because dizziness can have many possible causes — including blood pressure issues, anxiety, medication side effects and neurological problems — it’s important to have a thorough evaluation.

Mr Ramsden and the team at Oxford Hearing and Balance offer a full range of vestibular assessments to accurately identify the cause of dizziness and vertigo:

This measures how your eyes and inner ears work together when your head moves quickly. It helps assess the function of the semicircular canals in real time.

In this test, warm and cool air or water is gently introduced into the ear canal to stimulate the balance system. It helps determine if one ear is functioning less effectively than the other.

This measures balance-related reflexes and helps assess different parts of the vestibular system.

These assess how well your  inner ear hearing is working and measures the pressure in the middle ear directly.

With these tools, Mr Ramsden can develop a detailed understanding of your inner ear function and recommend tailored treatment, which may include balance retraining, head manoeuvres, dietary advice, or in some cases, surgery.