Dizziness & Tinnitus Center

Dizziness and tinnitus have many faces. Often several factors are present at the same time: a disorder of the balance system, tension in the neck, jaw dysfunction or stress. That's why we combine precise diagnostics with multimodal therapy.

• Conservative first: education, targeted exercises, manual and physiotherapeutic procedures
• Safe clarification of warning signs and sensible involvement of ENT/neurology
• Individual home programs (vestibular therapy, posture and eye-head training)
• Regenerative or interventional options only if there is a clear indication and after conservative options have been exhausted

Balance is calculated in the brain from several sources: the vestibular organ (inner ear), the eyes, the deep sensitivity of muscles and joints - especially from the upper cervical spine - and the autonomic nervous system. Jaw and chewing muscles can also have an influence via neck and brainstem connections.

• Vestibular organ: registers rotational and linear movements of the head
• Oculomotor skills: eyes stabilize the image (vestibulo-ocular reflex)
• Proprioception: Receptors in the neck, shoulders and feet report position information
• Jaw/CMD: Tension in the jaw can affect the neck muscles and ear region
• Autonomic nervous system: Stress and lack of sleep increase the perception of dizziness and tinnitus

Patients report very different feelings. The precise description is helpful for the diagnosis.

• Spinning, swaying, tipping, or lightheadedness
• Unsteadiness when walking, especially in the dark or on uneven surfaces
• Triggers such as head movements, changes in position, screen work or stress
• Tinnitus as whistling, hissing, humming – one or both sides, alternating
• Accompanying: neck and headaches, jaw clicking, ear pressure, nausea, sensitivity to light/sound
• Avoidance behavior, exhaustion, sleep problems

Many dizziness and tinnitus syndromes can be treated conservatively. Correct classification and differential diagnosis are crucial.

• Benign paroxysmal positional vertigo (BPLS): attacks of rotational vertigo lasting seconds when changing position; typically positive in the Dix-Hallpike test
• Vestibular neuritis or dysfunction of the vestibular nerve: Acute dizziness, often after infection; medical clarification required
• Vestibular migraine: dizziness with or without headache, sensitivity to light/sound
• Cervicogenic dizziness/cervical spine-related dizziness: connection with neck problems, visual stability disturbed
• Persistent postural-perceptual dizziness (PPPS/PPPD): Chronic staggering dizziness, triggered by sensory overload, fear or after a previous episode of dizziness
• Somatosensory tinnitus: Amplification or modulation of the noise in the ear by neck/jaw movements or pressure
• Craniomandibular dysfunction (CMD): temporomandibular joint and masticatory muscle problems radiating to the ear and neck
• Orthostatic intolerance/blood pressure fluctuations: lightheadedness when standing up
• Medication side effects, sudden hearing loss, Menière's disease: ENT/neurological assessment makes sense

Certain symptoms may indicate serious causes. Please note the following warning signs:

• Newly occurring, severe dizziness with neurological deficits (paralysis, speech/visual impairment, double vision)
• Acute sudden hearing loss, one-sided deafness or severe ear pain
• Sudden unsteady gait with a tendency to fall, especially with risk factors (cardiac arrhythmias, blood thinners)
• Severe neck/headache of an unusual kind
• Fainting, chest pain, shortness of breath

In these cases: Call 112 or go to an emergency room immediately.

We start with a structured, careful clarification. The aim is to rule out dangerous causes, understand the functional connections and derive a therapy plan from this.

• Detailed anamnesis: beginning, course, triggers, accompanying symptoms, medications, previous illnesses
• Validated questionnaires (e.g. DHI for dizziness, TFI for tinnitus) and stress assessment
• Clinical tests: balance, standing and gait tests, Romberg/Unterberger, head impulse test, gaze stability
• Positioning diagnostics: Dix-Hallpike, rolling test if BPLS is suspected
• Cervical spine, shoulder girdle and jaw findings: muscles, joints, trigger points, proprioception
• Oculomotor skills: saccades, smooth pursuit, vestibulo-ocular reflex (VOR)
• If necessary, cooperation: audiometry/ENT, neurology (e.g. in the case of sensory failures), dentistry (CMD), psychology
• Use technical procedures sensibly: imaging or laboratory only if there is a clear indication and warning signs

We discuss the results in an understandable way and prioritize measures that are expected to provide the greatest benefit.

The focus is on an active, everyday treatment that gradually leads you back to safety and resilience. We combine several building blocks – tailored to the diagnosis, goals and everyday life.

• Education & Reassurance: Understanding reduces fear and protective behavior
• Vestibular rehabilitation (VRT): habituation, gaze stabilization (PRE training), balance and gait training
• Positioning maneuvers in BPLS (e.g. Epley, Semont): Instructions and follow-up
• Manual therapy/cervical spine mobilization: gentle, function-oriented, combined with active exercises
• Sensorimotor training: head-eye coordination, posture, proprioception, breathing and tension regulation
• Physiotherapy with home exercise plan: short, regular sessions instead of overload
• Pain and trigger point management: myofascial techniques, heat/cold, ergonomic adjustments
• Medication options (e.g. for acute nausea) are – if necessary – prescribed in cooperation
• Return to activity: step-by-step plan for sport, work, travel and screen work

What is important is an adapted progression: sufficient stimulus for adaptation, but without being overwhelming. Short-term symptom provocation may be normal with VRT; the load is carefully increased.

Tinnitus is a symptom, not an independent clinical picture. There is no promise of a cure; Nevertheless, the burden can be significantly reduced through targeted measures.

• Audiological assessment and care: hearing aids or sound therapy in collaboration with ENT/acoustics
• Education & advice: realistic expectations, dealing with attention and triggers
• Cognitive behavioral therapy (CBT)-based strategies: proven effective in reducing tinnitus distress
• Sleep and stress management: sleep hygiene, relaxation techniques, breathing and biofeedback
• Somatosensory influence: treatment of neck/jaw tension, CMD co-therapy with dentists (e.g. splint concept)
• Sound therapy/masking: individually tailored; not equally effective for everyone
• Avoiding problematic noise exposure, but not excessive protection (take hyperacusis into account)

We coordinate the steps with you and our partners and rely on measures with a favorable risk-benefit ratio.

In selected cases, infiltrations or regenerative procedures may be useful, especially for treatment-resistant neck/shoulder pain that modulate dizziness or tinnitus. There is no reliable evidence for a direct “tinnitus cure”.

• Targeted infiltration of trigger points or small joints in the cervical spine to reduce pain and improve function
• Ultrasound or image-guided injections if there is a clear indication
• Orthobiological procedures (e.g. PRP) primarily for tendon/ligament problems; Benefit for tinnitus not proven

We only use these options after conservative measures have been exhausted and after transparent information about the benefits, risks and evidence.

Depending on the findings, we involve partner disciplines in order to avoid double examinations and to coordinate therapy.

• ENT/Neurootology: Hearing test, exclusion of sudden hearing loss/Menière, tinnitus diagnosis
• Neurology: Clarification of neurological deficits, headaches, polyneuropathy
• Dentistry/gnathology: CMD diagnostics, splint therapy
• Psychology/Psychotherapy: CBT, stress and anxiety management
• Physiotherapy and training therapy: implementation of exercise plans and progression
• Additionally, if desired: mindfulness-based procedures; TCM can be used as an adjunct – not as a replacement for medical diagnostics

• Arrive at Dorotheenstraße 48, 22301 Hamburg – please allow some lead time
• Structured anamnesis and review of your preliminary findings
• Targeted examinations (vestibular, cervical spine/jaw, balance, oculomotor function)
• Discuss results and prioritize next steps
• Start your individual exercise and action plan
• Coordinating further appointments and – if necessary – involving our network partners

Please bring with you: preliminary findings (ENT/neurology/imaging), medication list, hearing test if necessary, a list of your most important questions. Comfortable clothing makes functional and movement tests easier.

• Regular, guided exercises for gaze stability and balance
• Screen breaks, ergonomic workplace design, gentle neck mobility
• Sufficient sleep, fluids and a balanced diet
• Moderate physical activity: walking, cycling, light strength training
• Consciously dealing with jaw tension: relaxation exercises, resting the tongue
• Stress management: breathing exercises, short relaxation routines, daily structure

These instructions do not replace diagnostics. We will select the appropriate exercises with you individually.

Our vertigo & tinnitus center is located at Dorotheenstrasse 48, 22301 Hamburg. You can preferably receive appointments online via Doctolib or by email. We plan the duration of the initial appointment so that diagnosis and advice can be carried out in peace.