An evidence based approach to treatment of vertigo or dizziness without medication.

When the world literally spins !!
Dizziness or “chakkar“ is quite a common symptom. However, patients find it quite difficult to explain what exactly they mean when they say “I am feeling dizzy”.

Dizziness gets commonly categorized based on the description by the patient as

• Vertigo : false sense of spinning
• Disequilibrium and Imbalance : feeling unsteady or losing balance
• Lightheadedness or Presyncope : feeling faintness based on the description by the patient.

Some patients may feel a combination of the above symptoms along with a host of secondary symptoms like nausea, fatigue, headache, neck pain, hearing loss, sound in ears (tinnitus), weakness, difficulty in concentration, even severe concerns like arm or leg weakness or slurring of speech.
These different descriptors to explain what they feel as a patient is because dizziness is caused due to variety of factors like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular labyrinthitis, otosclerosis, Ménière’s disease, vestibular migraine, cervicogenic headache, stroke, multiple sclerosis, some types of tumors, some cardiac issues and sometimes even due to anxiety and depression.
infoKEM Newsletter FEBRUARY 2024 Issue 104 from KEM Hospital, PuneKNOW YOUR HEALTH For most patients, dizziness in any form causes significant distress as it increases discomfort, reduces the confidence in walking balance, increases the chances of falling and generally affects the quality of the patients’ personal and social lives. It has been found that 17 to 30% of adults will experience some form of dizziness in their lifetime.

This complexity in dizziness assessment and its treatment therefore needs a multidisciplinary team of specialists like ENT surgeons, physicians, neurologists, psychiatrists, audiologists and vertigo rehabilitation specialists. Vertigo is therefore best assessed and treated in specialized Vertigo Clinics like the KEM Hospital Vertigo and Balance Clinic .

The KEM Hospital Vertigo and Balance Clinic provides a comprehensive multidisciplinary assessment of dizziness for patients with both continuous and episodic (only in certain situations or positions) complaints of dizziness. Patients undergo assessments to find the cause of vertigo or dizziness. The evaluation involves clinical examination for central and cardiac causes of dizziness, blood pressure measurement in lying and standing positions, nystagmus assessment using video nystagmography (VNG), and Positional testing for BPPV (for positional triggered vertigo) as well as vertigo due to neck pain. This allows for accurate diagnosis of the cause of vertigo and thereby allows the patient to get the most effective treatment.

Another highlight of the KEM Hospital Vertigo and Balance Clinic is its specialised Vestibular Rehabilitation Therapy setup. We now know that 45% of dizziness symptoms come from the balance system in the inner ear called the “ vestibular system”, and sometimes it also occurs due to neck or cervical spine issues.

Vertigo which arises from the ear or neck results in people complaining about spinning sensations while moving the head or getting up or lying down in bed. It causes difficulty in doing simple everyday activities like looking up or down, walking around, using the computer or phone for a long time, driving, doing household work and results in loss of balance.

This type of vertigo or dizziness is due to neck pain, muscle weakness, ear based vestibular (balance) dysfunction or benign paroxysmal positional vertigo and these patients are referred to the vertigo rehabilitation clinic. Here, specialist physiotherapists will assess the cause by checking nystagmus (uncontrolled movements of the eye), they will also assess coordination, balance, pain and strength to confirm the causes of the vertigo, dizziness and loss of balance.

Based on finding the therapists will treat using vestibular rehabilitation therapy (VRT).

What is VRT?
Vestibular Rehabilitation Therapy (VRT) is a specialised form of therapy that involves a series of graded exercises (no medication) designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. This treatment may include canal repositioning, habituation exercises for decreasing fear of movement, gaze stability training, strength training and balance training.

Goals of VRT:

• Decrease symptoms of dizziness and disequilibrium
• Improve gaze stability
• Improve postural stability
• Decrease fall risk
• Improve functional mobility
• Improve participation in community, life roles


There is strong research evidence of the long-term success of VRT in treating vertigo in cases of vertigo arising from ear and neck conditions without the need of any medication. Vestibular Rehabilitation Therapy significantly reduces intensity and duration of dizzy spells and improves balance for activities of daily life so that you can regain your independence.