While a canceled concert is always annoying, it’s hard to fault singer George Ezra, who canceled gigs in London and Leeds this week after doctors diagnosed him with “acute vertigo”. Ticket holders have been told their tickets would remain valid should the shows be postponed – but how serious is the condition and is George likely to be affected in the future?
Dizziness causes those affected to experience severe dizzy spells and can give the feeling that the world is spinning. It’s a relatively common condition, slightly more common in women, but it’s thought to affect 40 percent of people at some point in their lives.
While dizziness can be caused by mild strokes and Ménière’s disease (a condition affecting the inner ear), these are “vanishingly rare,” says Mr Paul Montgomery, board-certified ear, nose and throat surgeon at King Edward VII’s Hospitals .and Cromwell. “The most common causes are either loosening crystals in the inner ear or a reaction to trauma.”
Just as a cough or runny nose can have multiple causes, so can dizziness. The two most common diagnoses that Mr. Montgomery refers to are Benign Paroxysmal Positional Vertigo (BPPV) and Persistent Postural Perception Vertigo (PPPD).
The former, BPPV, is generally much easier to correct. “You get displaced calcium crystals called otoconia in your inner ear, which makes you feel incredibly dizzy,” says Mr. Montgomery. “We see this a lot with people who’ve had a hit to the head, or sometimes with people who do a lot of Pilates. It also becomes more common as you get older.”
Luckily, there’s a simple manipulation called Epley’s Maneuver that realigns the inner ear crystals. “Most doctors can do it and it will resolve the dizziness either immediately or within a few days.”
The more complex version, PPPD, is more what Ezra suffers from and is often triggered by stress or trauma. Because of this, people often start feeling dizzy after a major life change, such as becoming a parent, retiring, or breaking up a relationship.
It can make sufferers feel like they’re constantly insecure, like they’re shaky or drunk. Left untreated, it can last for weeks, months, or even years.
“It’s essentially a brain response to injury — emotional, mental, or physical — and it could be a serious illness, untreated migraines, BPPV, inner ear problems, or just really bad news,” says Mr. Montgomery. “It’s the brain trying to deal with a glitch by installing a ‘software update,’ but it’s a bad program that doesn’t work.”
To understand this form of vertigo, it’s important to note that the human body doesn’t use the eyes to tell us we’re standing up straight. We rely on imperceptible signals from the neck, joints, and inner ears. But when we feel threatened, it can activate a fight-or-flight mode.
“You become hyper-alert and hyper-visual, with your eyes searching for threats,” explains Mr. Montgomery. “The brain suddenly starts using your eyes to control your muscles, but your eyes aren’t good at judging whether you’re standing up straight, so you suddenly start swaying.” Patients describe feeling as if their eyes are shaking or vibrate.
Most of us have probably experienced something like this at some point after receiving bad news, whether it be a bereavement or bad test results. It can feel like the world is spinning.
A classic component of this more solid form of vertigo is that it tends to be triggered by an “overly complicated visual environment,” says Mr. Montgomery. “Television and computer screens are a nightmare because they twist and turn a lot. I often see patients who can’t bear to walk through supermarket aisles because too much is going by their eyes at once, or who are perfectly happy driving at 50 km/h, but as soon as they drive over them they get dizzy. They depend on their eyes to make them feel stable and secure. When the visual environment starts spinning and changing pretty quickly, the brain gets overwhelmed – it can’t handle it.”
Stress blocks this response and it becomes a vicious circle. “Often the primary cause is — the bad infection or emotional trauma wears off, but you stay with that bad adjustment where you’re faltering, which re-triggers your fear and escape reflex,” says Mr. Montgomery.
Because of this, people often start feeling dizzy after a major life change, such as becoming a parent, retiring, or breaking up a relationship.
Interestingly, PPPD is typically diagnosed in patients like George Ezra. “It tends to occur in people who think a lot: writers, artists, painters, business executives,” says Mr. Montgomery. “People who live in an abstract front-of-brain world tend to be quite intelligent. Essentially those who tend to overthink.” Patients like this may be more prone to anxiety, which can activate the fight-or-flight response that leads to PPPD. For his part, Ezra revealed in 2020 that he experiences a version of OCD called “Pure O” that involves unstoppable obsessions.
“My own favorite theory is that the modern mind isn’t shutting down enough,” says Mr. Montgomery. “With social media, our phones, Netflix – we’re on all the time and it’s not good for you. An overactive brain is made worse by people overactivating the front of their brain.”