Vertigo treatment starts with the pattern, not with one test or one manoeuvre. Brief spinning when turning in bed, continuous vertigo lasting hours or days, dizziness with hearing change, and long-standing imbalance need different clinical pathways. Prime ENT Center in Hardoi provides non-emergency ENT and vestibular assessment; no test or treatment can guarantee an individual result.
When routine clinic booking is not the right first step
Seek emergency assessment now for new weakness or numbness, facial droop, slurred speech, double vision, inability to walk safely, fainting, chest pain, a new severe headache, sudden hearing loss, severe injury, breathing difficulty, or uncontrolled bleeding. Do not drive yourself while severe vertigo or imbalance is active.
How the symptom pattern guides evaluation
- Brief, position-triggered spinning: BPPV is one possibility. The affected side and canal should be assessed with the appropriate positional examination before a manoeuvre is selected.
- Continuous new vertigo with spontaneous nystagmus: this can represent an acute vestibular syndrome. HINTS is a trained-clinician examination used only in the correct clinical context; it is not a home test and a normal-looking result does not independently rule out stroke.
- Vertigo with tinnitus, ear fullness or hearing change: ear examination and audiometry may be needed. Sudden hearing loss requires urgent assessment.
- Persistent imbalance or blurred vision during movement: history, examination and selected vestibular tests may help define the next step. Normal testing does not make the symptom imaginary.
Tests used for different questions
Positional examination
Dix-Hallpike and supine-roll testing are used when the history suggests positional vertigo. The observed nystagmus pattern helps determine whether BPPV is likely and which canal-specific treatment may be appropriate.
Videonystagmography (VNG)
VNG records eye movements during selected oculomotor, positional and caloric tests. It may provide evidence of vestibular asymmetry, positional nystagmus, or an oculomotor pattern that needs further assessment. VNG does not by itself diagnose every cause of dizziness and does not independently exclude stroke, tumour, or another central disorder.
Functional Head Impulse Test (fHIT)
fHIT assesses functional gaze stability during rapid passive head impulses. The patient identifies briefly displayed visual optotypes and performance is reported as the proportion recognised correctly for the tested canal planes. fHIT is different from bedside HIT and vHIT, and it is not a standalone stroke-exclusion test.
Hearing and balance assessment
Audiometry, not VNG, documents a hearing-loss pattern. Other balance measurements may be useful for selected patients when fall risk, chronic imbalance, or rehabilitation planning is the clinical question. Tests are chosen after history and examination rather than as a fixed package for every patient.
BPPV treatment and the Bangalore Manoeuvre
Canalith-repositioning treatment is selected according to the affected canal, side, nystagmus pattern, movement safety, and clinical assessment. The Bangalore Manoeuvre is a repositioning technique described for selected cases of anterior-canal BPPV. It is not a general substitute for the Epley manoeuvre. Posterior- and horizontal-canal BPPV use their own canal-specific approaches.
Routine sleeping-position or head-movement restrictions are generally not required after a correctly performed repositioning procedure for posterior-canal BPPV. Individual advice can differ when mobility, neck or back disease, fall risk, another canal variant, or another medical issue changes the plan. Persistent or recurrent symptoms should be reassessed rather than treated with repeated unsupervised manoeuvres.
What patients should expect
A useful visit should clarify the working diagnosis, what evidence supports it, which dangerous alternatives need consideration, whether a test would change management, what to avoid while symptomatic, and when follow-up is needed. Improvement and recovery vary with the diagnosis, canal involved, associated medical conditions, fall risk, and whether symptoms have more than one cause.
Book a non-emergency assessment in Hardoi
For a routine vertigo, BPPV, hearing, tinnitus, or balance appointment, call +91 73930 62200 or message the clinic on WhatsApp. Bring current medicines, previous prescriptions, hearing tests, VNG reports, scans, and a short note of timing, triggers, hearing symptoms, headache, vomiting, falls, and recovery.
References
- AAO-HNSF Clinical Practice Guideline: BPPV (Update)
- GRACE-3: acute dizziness and vertigo in the emergency department
- NIDCD: balance disorders
Medical disclaimer: This page is for patient education and does not diagnose an individual. Emergency warning signs need emergency assessment rather than a routine clinic response.