Vestibular problems are a lesser‑known yet important factor contributing to falls.
If illness or injury damages the vestibular system, a person may feel dizzy, off‑balance, confused about their position in space, or experience spinning sensations. These symptoms can put them at risk of falling.
Sources of support
NHS Lothian ENT Balance Clinic
This is a specialised multidisciplinary clinic to investigate those who do not have BPPV and where history and examination makes an otological condition likely.
Multiple studies have shown that in patients referred to Balance Clinics:
- By FAR the commonest diagnoses are BPPV and Vestibular Migraine
- Please see below for management details:
- Vestibular migraine – diagnosis and Microsoft Word – refhelp migraine – Version sent – Nov 2024
- A THIRD to HALF of those referred have BOTH BPPV and vestibular migraine.
- Vestibular Neuritis and central neurological causes of vertigo are associated with a minority.
ENT specialists, a specialist Vestibular Audiologist and access to a balance physiotherapist, hearing tests and other Audiology services.
According to the history and examination, it may be advisable to exclude anaemia, diabetes or thyroid disorder.
The history is key, with four main groups of patients:
- Peripheral vertigo – BPPV by far the commonest see BPPV (Benign Paroxysmal Positional Vertigo) – RefHelp
- Vestibular migraine (and less commonly other neurological conditions)
- Balance issues in the elderly (multifactorial –Dizziness – RefHelp )
- Cardiovascular causes.
The ENT balance team will ask patients to complete a symptom questionnaire online prior to being given an appointment, with the option of a phone call for those who cannot manage this.
Further information and referral guidance is available on the following Refhelp pages:
ENT Dizziness and Balance – RefHelp
BPPV (Benign Paroxysmal Positional Vertigo) – RefHelp
Dizziness & Balance (MoE) – RefHelp
Vertigo and dizziness – RefHelp PDF: Vertigo and dizziness- advice for initial management in primary care
Useful links:
All Can Fall – Vestibular Disorders Association
The importance of falls Prevention and the Link to Vestibular Issues – Longevity Physiotherapy
Vestibular migraine – The Migraine Trust
World guidelines for falls prevention and management for older adults: a global initiative
