Each year five people out of every 1000 consult their general practitioner because of symptoms that are classified as vertigo; a further 10 in 1000 are seen for dizziness or giddiness.1 As many as one in four people aged 50 to 65 suffer from dizziness, which is even more common in elderly people.2 Despite the prevalence of and morbidity associated with balance disorders the value of vestibular rehabilitation is not widely recognised, and the availability of trained personnel and appropriate facilities is very limited both within and outside the health service.

Once the obvious and sinister causes for the symptom have been excluded patients are commonly reassured and advised to “learn to live with it.” Yet more serious investigation and active management is indicated as persistent dizziness or vertigo can result in chronic invalidism, with a severely circumscribed lifestyle, occupational disability, and a degradation in fitness, mobility, and balance that can have damaging repercussions in later life.3 Moreover, the drugs …