Vertigo — causes, diagnosis, and treatment
Vertigo is one of the most common reasons patients consult an ENT specialist. In most cases the cause is in the inner ear and is fully treatable — but there are also situations where the symptom points to a more serious condition that requires urgent workup.
What is vertigo?
In medical terms, vertigo is the sensation that either you are spinning or the space around you is spinning. It differs from presyncope (the feeling of being about to faint, without spinning) and from imbalance (a sense of losing equilibrium when moving). Accurately distinguishing these three sensations is key to the correct diagnosis — so describe in detail what you actually feel during the exam.
The most common causes of vertigo
More than 80% of vertigo cases originate in the peripheral vestibular system — the inner ear and balance nerve. This means the causes are ENT-related and fully treatable.
BPPV (benign paroxysmal positional vertigo)
The most common cause — 30–50% of all cases. It presents as brief, intense spells of vertigo triggered by certain head movements (rolling over in bed, looking up). It is caused by tiny calcium crystals (otoconia) that dislodge from their normal position and end up in the semicircular canals.
Ménière’s disease
Characterized by vertigo episodes lasting 20 minutes to several hours, accompanied by progressive hearing loss, tinnitus, and a sense of ear fullness. The cause is fluid accumulation in the inner ear.
Vestibular neuritis
Sudden, severe, and prolonged vertigo (days) without hearing loss, most often after a viral infection. The vestibular nerve becomes inflamed.
Labyrinthitis
Similar to vestibular neuritis but with hearing loss — inflammation of the entire inner ear, usually bacterial or viral in origin.
Other causes
- Vestibular migraine — vertigo as part of migraine attacks
- Acoustic neuroma — a benign tumor of the auditory nerve (rare, but important to rule out)
- Cervicogenic vertigo — related to a problem in the cervical spine
- Hypotension, anemia, hypoglycemia — systemic imbalances
⚠️ When vertigo is an emergency requiring immediate medical evaluation
If your vertigo is accompanied by any of these symptoms — go to the ER immediately or call emergency services:
- Sudden hearing loss
- A headache that is the worst of your life
- Difficulty speaking, weakness on one side of the body, double vision
- Inability to walk
- Loss of consciousness
- Chest pain, difficulty breathing
These symptoms may indicate a cerebrovascular event (TIA or stroke) that requires urgent care.
Diagnostics
Proper diagnosis of vertigo doesn’t boil down to “take a pill for vertigo.” We need to determine precisely which organ is producing the symptom and the specific cause. In our clinic we use:
- A detailed medical history — the most important step. We ask about the duration of episodes, what triggers them, whether you have hearing loss or headache, and whether you have had any infections.
- The Dix-Hallpike test — a positional test that confirms BPPV and identifies which semicircular canal is affected.
- Otoneurological examination — we check for nystagmus (involuntary eye movements), coordination, and balance.
- Audiometry and tympanometry — hearing assessment, since Ménière’s disease and other inner-ear conditions affect hearing.
- Endoscopy of the throat and Eustachian tube — when vertigo is combined with middle-ear symptoms.
How vertigo is treated
Treatment depends on the diagnosis. The most common approaches we use:
Repositioning maneuvers (for BPPV)
The Epley maneuver and other repositioning techniques return the crystals to their normal place. It often succeeds on the first attempt — patients leave the clinic without vertigo.
Medical therapy
For Ménière’s disease we use betahistine, diuretics, and a low-salt diet. For vestibular neuritis — corticosteroids and vestibular rehabilitation.
Vestibular rehabilitation
Physical therapy that helps the brain compensate for vestibular dysfunction. Very effective for chronic forms.
Surgical treatment
Rarely needed. In specific cases of Ménière’s disease unresponsive to medication, intratympanic therapy or surgery is considered.
💡 Tips for patients with vertigo
- During an attack — sit or lie down, fix your gaze on a stationary object
- Avoid sudden head movements and rapid standing
- Reduce salt intake (if Ménière’s is suspected)
- Note exactly what triggers an attack — it helps with diagnosis
- Don’t self-diagnose — vertigo can have many causes that are treated differently
Related topics
👂 Ear & hearing (hub)
🔊 Tinnitus
👂 Hearing loss
🔍 All symptoms
Persistent vertigo?
Schedule an ENT consultation at ELITE clinic. A proper diagnosis means fast, effective treatment — we often know what’s going on from the very first visit.