“I’ve been dizzy for nineteen months. Is there anything I can do myself?”
A consultant ENT surgeon answers a reader — and explains the ninety-second fix most people are never shown.
The short version
- Dizziness that lasts under a minute and starts when you move your head is almost always mechanical — not neurological.
- Loose crystals have drifted into the wrong part of the inner ear. Waiting does not move them.
- A sequence of positions puts them back. About 90 seconds, and roughly 80% of cases resolve after one done correctly.
- It has to match the right canal, each position held a full thirty seconds, with the right aftercare.
“It’s dizzy when I roll over onto my left side, and when I look up at the top shelf, and when I bend to the bottom oven. Twenty seconds, then it goes — and then I’m frightened of it all day.
I’ve stopped sleeping on my left side. I’ve stopped driving. Last month I missed my grandson’s christening and told everyone it was my chest.
I’m 69, and I’ve already given away a year and a half of it.”
Dear Jean — yes, almost certainly there is.
I’m going to answer your question directly, because you’ve waited nineteen months for somebody to, and that is nineteen months too many.
Everything in your letter describes the commonest cause of vertigo we see. The important word in its name is the one people skip over: positional.
It happens when you move your head into a particular position. It stops when you stay still. And it has, in the overwhelming majority of cases, a mechanical cause and a mechanical fix.
This applies to short, positional spinning with normal hearing. It does not apply if your dizziness comes with sudden severe headache, double vision, slurred speech, weakness or numbness on one side, chest pain, fainting, or new hearing loss in one ear. Any of those needs urgent assessment today — not a home programme. Please stop reading and get seen.
What’s actually happening in there
Inside your inner ear, in a chamber called the utricle, sits a small bed of calcium carbonate crystals. Their job is to tell your brain about gravity — they are, literally, how you know which way is up.
With age, or after a knock to the head, or a spell lying flat with an illness, some come loose. They drift into one of the semicircular canals next door — the fluid-filled loops that detect rotation.
The spinning you feel is not your body failing. It is your brain doing sensible arithmetic with one input that is lying to it.
That’s why it lasts about twenty seconds — roughly how long the crystals take to settle. It’s why it happens rolling onto one particular side.
And it is why, Jean, nineteen months of waiting has changed nothing. The crystals are still in the wrong place, and nothing about the passage of time moves them.
Why the tablets didn’t work
They were never going to. Betahistine, prochlorperazine, the travel-sickness class — these are vestibular sedatives. They dampen the alarm signal. They do not touch the crystals setting it off.
Worse, and I say this to patients constantly: taken beyond a few days they actively work against you. Your brain recovers from vestibular problems by recalibrating, and it needs those signals to do the recalibrating. Suppress them and people often feel foggier and less steady the longer they stay on them.
of cases resolve after one correctly-performed sequence
The fix itself
It is a sequence of head and body positions performed in a specific order, each held for about thirty seconds. It uses gravity to walk the crystals back around the canal and tip them out into the chamber they escaped from.
This film shows what the sequence involves. It is an overview, not a set of instructions to follow along with — which side and which canal your crystals are in determines the version you need, and that is what the assessment establishes. Do not attempt it from this film alone.
Take the 1-minute assessment →So why hasn’t anyone done it for you?
There are three, and the sequence differs for each. Perform the wrong one and you can move the crystals somewhere less convenient than where they started. This is the honest reason we’re cautious about telling people to simply look it up.
Each position needs a full thirty seconds. The commonest failure I see is rushing — moving on after five because it’s unpleasant. Done at speed it does nothing, and people conclude it doesn’t work for them.
Diagnosing the side, performing the manoeuvre and teaching it does not fit a standard appointment. So it gets referred onward to a service with a long queue — and people lose a year and a half, and a christening.
What it feels like when it works
I should be honest with you about the first attempt, because people are often frightened by it.
As the crystals move through the canal you may get a strong burst of spinning — sometimes stronger than your usual episode. That is not a sign something has gone wrong. It is usually the clearest sign it is going right.
It passes in under a minute. Do it sitting on a bed rather than a chair, and have somebody in the room with you the first time.
The part everybody forgets
Once repositioned, the crystals are sitting loose in the chamber they belong in — not yet settled, not yet reabsorbed. Lie flat on the affected side too soon and they can drop straight back into the canal you just cleared.
So for forty-eight hours: sleep propped at roughly forty-five degrees, stay off the affected side, and take care with head position. Simple, and almost never explained — which is why so many people do the sequence, feel wonderful, and find it back within the week.
What I’d want you to have
If you were sitting in my clinic, I’d first work out which side and which canal from how your symptoms behave. Then perform the sequence with you, slowly, talking you through each position. Then send you home knowing how to repeat it, what to expect, and how to sleep for the next two nights.
That is what a colleague and I put into Steadi: the questions that establish the likely side, the sequence filmed slowly from three angles, a printed card for the bedside, and the aftercare that decides whether it holds.
It is not a replacement for a clinician and I would not pretend it is. It is the ninety seconds you have been waiting nineteen months for, explained properly.
Go and look at the christening photographs, Jean. Then go and get your keys back.
Questions readers ask
From how your symptoms behave — which way you roll when it starts, which shoulder you avoid sleeping on. The assessment walks through those questions before showing you anything.
Duration doesn’t much matter. The crystals don’t become harder to move over time — they simply stay where they are. Long-standing cases respond in the same way.
Not without speaking to a clinician first. Recent neck injury, cervical spine surgery, carotid or vertebral artery disease, or retinal detachment all rule out the standard sequences.
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Steadi — the at-home vertigo & dizziness method
The repositioning sequence used in vestibular clinics, matched to your trigger and filmed slowly from three angles.
- Your personal reset plan
- The 3-Position Reset Card for the bedside
- The Morning Get-Up Sequence
- 8-Minute Balance & Fall-Prevention Plan
- Sleep Positioning Guide
- Your dedicated coach
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“Jean” is a composite of reader correspondence; identifying details have been changed. Steadi is an educational movement program. It is not medical advice, not a diagnosis and not a substitute for assessment by a clinician. Do not attempt the sequences if you have had a recent neck injury, cervical spine surgery, carotid or vertebral artery disease, or a retinal detachment. Dizziness accompanied by sudden severe headache, double vision, slurred speech, weakness or numbness on one side, chest pain, fainting or new hearing loss in one ear requires urgent medical assessment — contact emergency services. Results vary.