Persistent Postural Perceptual Dizziness (3PD)
Persistent Postural Perceptual Dizziness (3PD)
Patient Information
ENT Department
- Author ID: RS / SM
- Leaflet Ref: Ent 006
- Version: 1
- Leaflet title: Persistent Postural Perceptual Dizziness (3PD)
- Date Produced: September 2025
- Expiry Date: September 2027
What is Persistent Postural Perceptual Dizziness (3PD)?
3PD is a condition where you feel dizzy or unsteady almost all the time, especially when you are upright, moving, or in busy, visually stimulating environments (like supermarkets or crowded areas).
Although these symptoms are nearly constant, they might get better or worse during the day.
Because of dizziness, you may feel anxious about losing your balance or falling. This anxiety can make your symptoms worse, leading you to avoid situations that trigger dizziness, which in turn can make the problem more challenging to manage.
What causes 3PD?
Your balance depends on input from three sources:
1. Inner Ears: These help you to sense changes in head position.
2. Eyes: They provide visual information.
3. Legs and Feet: Sensors in these areas tell you about your body’s position.
Your brain uses input from these three sources to co-ordinate a sense of balance, and adjusts your muscles to keep you stable and to prevent you from falling.
Often, 3PD occurs following an initial problem in your inner ears that affects your balance (e.g. infection, migraine or Meniere’s disease). When your inner ear is affected, your brain starts relying more on your eyes and the sensors in your legs and feet. Even after the ear problem improves, your brain may take time to readjust. In 3PD, the brain does not fully readjust, and 3PD results, causing persistent dizziness with postural changes or with certain visual stimuli.
Occasionally, 3PD happens without an ear problem and is mainly related to anxiety.
How can 3PD be managed?
A combination of treatments can help you manage 3PD. Treatment plans are tailored to each individual, and may involve several approaches:
1. Vestibular Rehabilitation Therapy (VRT)
This specialised physical therapy focuses on exercises that help your brain re-learn how to balance.
You may be given exercises to do at home. Start slowly as tolerated, and gradually make the exercises harder (e.g., by standing up, adjusting your foot position, or gently moving your head).
Your doctor may refer you for specialist balance physiotherapy.
2. Medications
Certain medications (like antidepressants at a low dose) may be prescribed to help manage anxiety, depression or other related symptoms. These medications have been shown to help balance symptoms in people suffering with 3PD, even in the absence of significant anxiety and depression. Your doctor will suggest medications based on your individual needs.
3. Lifestyle Modifications
Regular exercise, stress reduction techniques and a consistent sleep schedule can all help to manage your symptoms.
Slowly reintroducing busy environments (for example, starting with short visits to a supermarket) can also help you build confidence and improve symptoms.
4. Cognitive-Behavioural Therapy (CBT)
CBT helps you understand and change negative thought patterns and behaviours that can increase your dizziness and anxiety. It can build better coping skills and reduce the impact of anxiety on your symptoms.
5. Mindfulness and Meditation
These techniques help you stay present and reduce the cycle of anxiety that can worsen your dizziness. Mindfulness involves paying attention to your breathing, body sensations, and the sounds around you. Over time, this can help you accept your dizziness rather than fighting it, which may reduce the intensity of your symptoms.
Summary
3PD is a long-term condition that usually requires ongoing management. It may take some time to find the right combination of treatments that work best for you. Working closely with healthcare professionals who are experienced in managing 3PD can make a significant difference in your recovery and quality of life.
If you have any questions or concerns, please do not hesitate to speak with a member of our team.
Remember: You are not alone in this journey, and with the right strategies, you can regain control and improve your overall well-being.