Vestibular Specialist in Dubai – Dizziness, vertigo & Balance Assessment
If you experience vertigo, dizziness or balance problems, Dr. Nanor Tchaghlasian provides specialist vertigo and vestibular assessment in Dubai to help identify the underlying cause and guide appropriate treatment.
Common causes of dizziness include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular migraine, Ménière’s disease and other inner-ear disorders. A detailed medical history, clinical examination and specialized vestibular tests, when indicated, can help determine the cause of your symptoms.
How Does Our Balance System Work?
Maintaining balance depends mainly on information received by the brain from three systems:
- The vestibular system of the inner ear, which detects head movement and position.
- Vision, which provides information about our surroundings and orientation.
- The sensory system, particularly information from the muscles, joints and feet about body position.
The brain continuously combines information from these systems to maintain balance and stable vision while we move.
A disturbance in one or more of these systems may result in vertigo, dizziness, imbalance or unsteadiness.
When Should You Have a Vestibular Assessment (balance tests) ?
A vestibular assessment may be recommended if you experience:
- Spinning vertigo
- Recurrent or persistent dizziness
- Dizziness triggered by turning in bed, lying down or looking up
- Imbalance or unsteadiness while walking
- Dizziness triggered by rapid head movements
- Recurrent unexplained falls
- Persistent dizziness following an acute attack of vertigo
- Dizziness associated with hearing loss, tinnitus or pressure in the ear
- Difficulty maintaining balance in darkness or on uneven surfaces
And If you have plus to the dizziness any of the following other symptoms, be sure to seek emergency medical care:
- Chest pains
- Numbness or tingling
- Falling or problems walking
- Weakness in the legs or arms
- Blurred vision
- Slurred speech
- Sudden hearing loss
- Severe neck stiffness
- Head trauma or injury
- High fever
Why Are Vestibular Balance Tests Needed?
Balance tests determine:
- What is the cause of the problem?
- Where in the balance system is the problem?
- What are the changes that happened in the balance system? Are they temporary or permanent?
This information will help the doctor to find the diagnosis and to choose the proper management plan.
What Are the Vestibular Tests?
Bedside balance tests: They are mainly done by observing your eyes in different head and body positions. The most important finding which the doctor will be looking for is nystagmus (special kind of involuntary eye movements which helps the doctor to differentiate between different causes of vertigo or dizziness).
Sometimes bedside balance tests will not be enough , so more detailed vestibular tests are needed
These may include:
Videonystagmography (VNG)
VNG is done with a google fixed firmly over your eyes, tracking and recording your eye movements with camera as you look back and forth between designated points or move your head and body into different positions.
Video Head Impulse Test (vHIT)
vHIT evaluates the function of the semicircular canals and the vestibulo-ocular reflex during rapid head movements.
VEMP Testing
Cervical and ocular Vestibular Evoked Myogenic Potentials (cVEMP and oVEMP) may be used to assess specific parts of the inner-ear balance system and vestibular pathways and done by putting electrodes on the neck , around the eyes and recording muscles activity as response to loud sounds.
Not every patient requires every test. The appropriate investigations are selected according to the symptoms and clinical findings.
Common Causes of Vertigo and Dizziness
1.BPPV
The most common cause of vertigo seen in ENT clinics is benign paroxysmal positional vertigo, or BPPV. Spinning vertigo lasts for seconds to minutes. It is not constant might occur whenever tipping the head up or down, lying down, or turning over or sitting up in bed. Sometimes the vertigo will be severe and will accompany with nausea and vomiting. The patient doesn’t experience any hearing loss or ear pressure or ringing sounds in the ear.
Why BPPV Happens?
The ear has small crystals called “otoconia” which is normally located in the utricle. For some reason these crystals will come loose and dislodged from its place and will fall in one of the semicircular canals moving freely in the fluid with special head positions causing spinning sensation (vertigo) whenever the head is in that position.
How is BPPV Diagnosed?
The diagnosis is based on history and findings on physical examination. The doctor might do several bedside balance tests which are mainly done by observing your eyes in different head and body positions. The most important finding which the doctor will be looking for is nystagmus (special kind of involuntary eye movements which helps the doctor to differentiate different causes of vertigo or dizziness. It is important for the doctor to decide which ear is affected and which canal is affected to choose the proper repositioning maneuver for treatment.
These tests can be done without recording or with recording with VNG.
How is BPPV treated?
BPPV is easily treated in the office by repositioning maneuvers. The aim of these maneuvers is to make the crystals fall back into its place by putting the head in different positions. Each canal involvement has specific maneuver( Eupley, Semont, Barbeque maneuvers and esc…) The doctor has to decide according to your exam result which ear and which canal has to be treated.
2. Ménière’s Disease – Symptoms, Diagnosis and Treatment
What Is Ménière’s Disease?
Ménière’s disease is a disorder of the inner ear that causes recurrent episodes of spontaneous vertigo, fluctuating hearing loss, tinnitus (ringing or buzzing in the ear), and a sensation of fullness or pressure in the affected ear.
The condition usually affects one ear, although both ears may become involved in some patients.
Vertigo attacks typically last between 20 minutes and 12 hours and may be accompanied by nausea, vomiting and difficulty maintaining balance.
Ménière’s disease is associated with an abnormal accumulation of fluid within the inner ear, known as endolymphatic hydrops. However, the exact cause of the disease is not fully understood.
Illustration comparing a normal inner ear with endolymphatic hydrops associated with Ménière’s disease
What Are the Symptoms of Ménière’s Disease?
Common symptoms include:
- Recurrent attacks of spontaneous spinning vertigo
- Fluctuating hearing loss, usually affecting one ear
- Tinnitus (ringing, buzzing or roaring sounds)
- A feeling of pressure or fullness in the affected ear
- Nausea and vomiting during vertigo attacks
- Imbalance or unsteadiness during or after an attack
Hearing may fluctuate during the early stages of the disease. Over time, some patients may develop persistent hearing loss.
How Is Ménière’s Disease Diagnosed?
Diagnosis is based on a detailed medical history, the pattern and duration of vertigo attacks, and hearing assessment.
Pure tone audiometry is important to identify and document sensorineural hearing loss.
Vestibular investigations, including videonystagmography (VNG), caloric testing and video head impulse testing (vHIT), may be recommended when clinically indicated to assess vestibular function and help differentiate Ménière’s disease from other vestibular disorders.
An MRI may be required in selected patients to exclude other causes of hearing loss or dizziness.
Other conditions, particularly vestibular migraine, should also be considered during the diagnostic assessment.
How Is Ménière’s Disease Treated?
Although there is currently no definitive cure for Ménière’s disease, several treatment options may help reduce the frequency and severity of vertigo attacks and improve quality of life.
Treatment is individualized according to the severity of symptoms, hearing status and response to previous treatment.
Lifestyle and Dietary Management
Patients may benefit from:
- Maintaining regular meals and adequate hydration
- Keeping a consistent daily routine and sleep schedule
- Reducing excessive salt intake when appropriate
- Identifying individual triggers, which may include caffeine or alcohol
- Avoiding smoking and nicotine products
- Managing stress and maintaining regular physical activity when possible
Evidence supporting specific dietary restrictions is limited. Dietary recommendations should therefore be individualized rather than applied strictly to every patient.
Medical Treatment
Depending on the clinical findings, treatment may include:
- Short-term medication to relieve severe vertigo, nausea and vomiting during acute attacks
- Maintenance treatment, such as betahistine or diuretics, which may be considered in selected patients
- Hearing rehabilitation, including hearing aids when appropriate
Intratympanic Injections
For patients with persistent or recurrent vertigo despite conservative treatment, intratympanic medication may be considered.
Intratympanic steroid injections may help control vertigo in selected patients while generally presenting a lower risk of hearing damage than gentamicin.
Intratympanic gentamicin may be considered for refractory disease, but its potential effects on hearing and vestibular function require careful discussion.
Vestibular Rehabilitation
Vestibular rehabilitation therapy may be recommended for patients experiencing persistent imbalance between vertigo attacks. It is not intended to treat an acute Ménière’s vertigo attack.
Surgical Treatment
Surgery may be considered in selected patients with severe, disabling vertigo that remains uncontrolled despite appropriate nonsurgical treatment.
When Should You Consult a Vestibular Specialist?
If you experience recurrent spontaneous vertigo, fluctuating hearing loss, tinnitus or pressure in one ear, a sp
ecialist assessment can help determine whether Ménière’s disease or another vestibular condition is responsible.
Early assessment is particularly important when hearing changes occur.
Sudden hearing loss requires urgent medical assessment, even if it occurs without vertigo.
3. Acoustic Neuroma
Benign slow growing mass that occasionally occurs on the hearing and balance nerve. It presents with hearing loss and tinnitus (sounds in the ear) in one side.
Any patient with an unexplained progressive hearing loss and ringing sound only in one ear should get a MRI to rule out the tumor.
Most commonly, an acoustic tumor is treated with Observation with serial MRI-s, surgery or radiation to prevent complications caused with ongoing tumor growth.
4. Vestibular Neuritis – Symptoms and Treatment
What Is Vestibular Neuritis?
Vestibular neuritis is a disorder affecting the vestibular nerve, which carries balance information from the inner ear to the brain. It causes sudden, severe, continuous vertigo, usually lasting more than 24 hours.
The condition may be related to inflammation of the vestibular nerve, although the exact cause is not always known. Unlike other inner-ear disorders, vestibular neuritis usually does not cause hearing loss or tinnitus.
What Are the Symptoms?
- Sudden, continuous spinning vertigo lasting more than 24 hours
- Nausea and vomiting
- Imbalance and difficulty walking
- Dizziness that worsens with head movements
- Persistent unsteadiness during recovery
How Is Vestibular Neuritis Diagnosed?
Diagnosis is based on the patient’s symptoms and a detailed neurological and vestibular examination.
Specialized vestibular tests, including Video Head Impulse Test (vHIT), Videonystagmography (VNG) and caloric testing, may help identify weakness of the affected vestibular system.
It is important to exclude other causes of sudden vertigo, particularly stroke.
How Is Vestibular Neuritis Treated?
During the acute stage, short-term medication may be prescribed to control vertigo, nausea and vomiting. Corticosteroids may be considered in selected patients, although their long-term benefit remains uncertain.
Prolonged use of vestibular suppressants is avoided because it may delay vestibular compensation.
Vestibular rehabilitation therapy is an important part of recovery. Early, gradual mobilization and individualized exercises can help improve balance, reduce dizziness and promote recovery.
How Long Does Recovery Take?
Severe vertigo usually improves within several days, but imbalance and motion sensitivity may persist for weeks or months.
Most patients improve gradually, although some may experience persistent dizziness requiring further assessment and vestibular rehabilitation.
When Should You Seek Emergency Care?
Sudden vertigo accompanied by double vision, slurred speech, limb weakness, severe difficulty walking, new severe headache or sudden hearing loss requires urgent medical assessment.
