Medicosnext
Dr. Sangya Paudel
She is a consultant ENT surgeon at UDM-NINAS, Bansbari. She works in the general ENT and has a special interest in Neurotology Vestibular Science. She has 10 years of experience in the field and has touched the lives of thousands of patients. She is the executive member of Society of Otolaryngology Nepal and Nepalese Society of Equilibrium and Balance.
Recently, a 64-year-old gentleman walked into our outpatient clinic with a sudden onset of dizziness. He was unable to walk steadily and had repeated episodes of vomiting. After a detailed evaluation, including videonystagmography, he was diagnosed with bilateral vestibular hypofunction- a condition in which the organs in the inner ear that help with balance had failed to function in both the ears. He was admitted, treated according to the established protocol and he gradually regained his balance before being discharged. Had he delayed seeking medical care, he might have endured months or even years of persistent dizziness and imbalance, affecting his daily activities and the quality of life. He is just one of the many patients who visit our Vertigo Clinic.
More Than Just Dizziness
Vertigo is one of the most common yet frequently overlooked symptoms encountered in clinical practice. Every year, approximately 1.4-1.8% of the population experience a new episode of vertigo. The likelihood increases significantly with increasing age, particularly after 60, and studies estimate a lifetime prevalence of approximately 7-10 percent of general population.
According to Barany’s Society, vertigo is defined as “the sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement.” People often describe it as spinning, tilting, swaying, rocking, bouncing, or the feeling that either they or their surrounding are moving when they are actually still.
How Our Balance System Works
Maintaining balance is a remarkable teamwork between several body systems. The brain integrates information from the vestibular organs of the inner ear, the eyes, the receptors in our muscles and joints that detect body position (proprioception). When any one of these systems malfunction, vertigo or imbalance can occur.
In some individuals, prolonged balance disorder can even lead to changes in how the brain processes balance signals. Even after the original illness or the primary disease is resolved, persistent dizziness may continue, especially in people who develop anxiety related to their symptoms. This ongoing trait can significantly reduce the quality of life.
Finding the Real Cause
Vertigo is not a disease, it is a symptom. Identifying its cause is the key to successful treatment.
When a person with vertigo visits a hospital, they should first be seen and thoroughly assessed by an ENT specialist to determine whether the problem originates from the inner ear, known as a peripheral vestibular disorder. If no peripheral cause is identified, evaluation by neurologist becomes essential to rule out central nervous system condition such as a stroke or other neurological diseases.
Depending on the patient’s symptoms, further assessment by a cardiologist, an ophthalmologist, a psychiatrist, a psychologist or other specialties may also be necessary.
Fortunately, the majority of the cases arise from disorder of peripheral vestibular system. Common causes include:
- Benign paroxysmal positional vertigo
- Meniere’s disease
- Vestibular migraine
- Vestibular Neuronitis
- Labyrinthitis, etc.
Accurate diagnosis requires careful history-taking, a detailed physical examination, and specialised vestibular investigations. Tests such as videonystagmography, vestibular function testing, and imaging studies like MRI when clinically indicated, help clinicians to identify the underlying problem and guide appropriate treatment.
Recovery may require more than just medication
Treatment for vertigo may require more than medicines alone. Vestibular rehabilitation has become one of the most effective approaches for helping patients recover balance and confidence after acute vestibular disorder. People with central or vestibular disease may need balance rehabilitation for balance restoration. Specially designed balance exercises, guided by trained Physiotherapist plays significant role in later stages of rehabilitation. Newer technologies like virtual reality based exercises are newer generation treatment for balance issues. This will help people with chronic balance disorder to regain their balance.
Building a Better Future for Vertigo Care
Recognising the growing need for comprehensive care, the Nepalese Society for Equilibrium and Balance was established on 27th June 2026. The society brings together ENT surgeons, neurologists, psychiatrists, physiotherapists, audiologists and other health care professionals with a shared mission to improve the diagnosis and management of vertigo and balance disorders. Its vision is to promote multidisciplinary collaboration through continued medical education, conferences, research, and public awareness initiatives. By educating both healthcare professionals and the community, the society aims to ensure that patients receive timely, accurate, and evidence-based care.
Don’t Ignore the Spinning
Vertigo is never a symptom to take lightly. While many cases result from treatable disorders of the inner ear, others may signal serious conditions such as stroke which is a medical emergency requiring immediate medical attention.
