3PD, or Persistent Postural Perceptual Dizziness is a vexing condition that causes a person to experience a constant sensation of dizziness or unsteadiness in the wake of a triggering event such as a migraine, concussion, vestibular neuritis, labyrinthitis, BPPV or head trauma.
A sense of persistent dizziness is the primary symptom of 3PD (PPPD). The dizziness has been described in many ways including vertigo, lightheadedness, rocking, veering, bobbling, the sensation of the world tilting. In association, there can also be other symptoms such as heavy-headedness, fogginess, foggy head, difficulties with concentration, disorientation, and discombobulation. ,. When a sufferer is experiencing 3PD (PPPD) any movement can amplify the off-balance feeling. For most people symptoms are at their worst in crowded places or when there is a significant amount of visual stimulation. For others, movement of the head in any direction can also make symptoms worse.
Research is ongoing but at this time evidence supports the idea that 3PD is a result of the brain’s heightened awareness and sensitivity to your balance and surroundings. It is usually triggered by an event, which may still be present, causing changes in how the brain processes information from your inner ear vestibular system and vision.
How is it diagnosed?
3PD is diagnosed by first eliminating other potential causes of the patient’s symptoms and confirming the patient has experienced PPPD symptoms for at least 3 consecutive months. Diagnosis can be tricky because 3PD symptoms do not appear on X-rays, MRIs, or CAT scans. Hence, detailed assessment is required to avoid misdiagnosis. This includes detailed history, examination of the balance system, and tests of hearing and vestibular function. An MRI scan is usually requested to check for other structural abnormalities such as a brain tumour. Blood tests may also be conducted.
How is 3PD treated?
Research indicates around 80% of patients improve with treatment, some experiencing complete resolution. Treatments include balance rehabilitation (vestibular rehabilitation), cognitive behavioral therapy (CBT), and certain medications. Physical therapy may also be used to retrain the body and mind to react to motion normally.
What medications are used to treat 3PD?
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications. These antidepressants have been shown to reduce dizziness in PPPD.
Is 3PD a psychiatric condition?
No. Although anxiety or depression can trigger it, or persistent undiagnosed symptoms may result in low mood, many 3PD patients show no signs of anxiety or other health problems. It is not a psychiatric disorder.
The Care Quality Commission (CQC) is a public body of the Department of Health and Social Care established to regulate and inspect health and social care services in England. CQC registration is a marker for standards of care. It is a mandatory requirement of all organisations which provide vestibular care or diagnostics.
Find answers to common questions about hearing loss, treatment options, and how our specialists can help.
Audiovestibular Medicine is a physician-led speciality dedicated to diagnosing and managing disorders of hearing and the inner-ear balance system. It focuses on non-surgical, evidence-based care for conditions like chronic dizziness, vertigo, ringing in the ears, sound sensitivity, and complex hearing disorders. AVM specialists understand how audio and vestibular systems connect with neurology, ageing, and daily functioning, offering patients accurate diagnosis, long-term management, and improved quality of life through tailored treatment plans.
Our clinic provides comprehensive medical diagnostics and personalised management for hearing and balance disorders. Core services include advanced hearing assessments, inner-ear balance evaluations, tinnitus profiling, dizziness diagnostics, guidance on vestibular physiotherapy, and long-term rehabilitation strategies. We assess both peripheral and central vestibular influences and manage complex cases requiring integrated care. Patients receive structured follow-up support, lifestyle-aligned therapy pathways, and precise clinical insight led by expert specialists practising at Harley St Medical Area.
Our clinic stands apart through medically led, integrated AVM expertise, assessing hearing and balance as connected systems rather than isolated symptoms. We combine advanced diagnostics, root-cause investigation, personalised management, and rehabilitation-driven care for chronic or complex inner-ear and neuro-vestibular conditions. Patients receive tailored therapy pathways, clinical precision, multidisciplinary guidance, structured follow-ups, and human-first care planning. Our approach redefines patient outcomes by merging medical insight with long-term, quality-of-life-focused support.
Patients who experience persistent ringing in the ears, sound sensitivity, progressive or complex hearing loss, recurring vertigo, imbalance, or unexplained chronic dizziness benefit most. We support individuals requiring non-surgical diagnosis, inner-ear clinical insight, rehabilitation guidance, or long-term symptom management. Complex cases overlapping auditory and vestibular dysfunction, migraine-linked dizziness, or neuro-otological influences are carefully assessed. Our specialists design customised care plans and therapy pathways to restore clarity, comfort, and stability for everyday life. An Audiovestibular Physician (AVP) is a medical doctor who specialises in Audiovestibular Medicine.
We are not a surgical ENT clinic. Our clinic is dedicated exclusively to Audiovestibular Medicine, focusing on medically rigorous, non-surgical diagnosis and management of hearing- and inner-ear-related balance disorders. Our core work remains advanced clinical diagnostics, chronic condition management, vestibular therapy pathways, hearing rehabilitation, and holistic patient support. Our team blends auditory and vestibular medical expertise to deliver precise, specialist-first care.
Hearing and balance disorders can worsen subtly, affecting safety, confidence, communication, work, mobility, and emotional well-being. Early AVM diagnosis identifies underlying inner-ear or neuro-vestibular causes, preventing misdiagnosis and long-term decline. Patients receive timely medical management, therapy guidance, and rehabilitation planning, reducing complications like falls, anxiety, or worsening auditory strain. Early detection leads to better stability, stronger treatment outcomes, improved daily functioning, and long-term quality-of-life benefits guided by expert clinic protocols.
Get in touch with our experienced team to book a consultation or learn more about hearing loss solutions.
