Vertigo – Dizziness
Vertigo is the sensation that you or your surroundings are spinning. It differs from light-headedness, unsteadiness or fainting. The body's balance centre lies in the inner ear, so the most common source of true spinning is the ear — and evaluation starts with an ENT examination.
Most common causes
- BPPV ("loose crystals"): the most frequent cause. Intense spinning lasting seconds, triggered by turning in bed or bending over, caused by displacement of microscopic crystals in the inner ear.
- Vestibular neuritis: usually viral inflammation of the balance nerve; severe spinning with nausea lasting hours to days, with normal hearing.
- Meniere's disease: increased inner ear fluid pressure; recognised by the quartet of vertigo attacks + ear fullness + tinnitus + fluctuating hearing loss.
- Vestibular migraine: an important cause of recurrent dizzy spells in people with a headache history.
- Less commonly: middle ear infections, medication side effects, vascular and neurological disease.
When is vertigo an emergency?
Go to the emergency department if spinning is accompanied by double vision, slurred speech, numbness or weakness of the face or arm, severe headache, or inability to walk — these may indicate stroke. Vertigo with sudden hearing loss also requires urgent treatment.
Diagnosis
The key is a detailed history: the duration, triggers and accompanying symptoms usually point to the diagnosis. Positional tests (Dix-Hallpike) are performed during the examination; hearing tests and imaging are added when needed.
Treatment
BPPV is treated not with drugs but with repositioning manoeuvres (Epley): the crystals are guided back into place with specific head movements during the consultation, and most patients improve in the same session. Vestibular neuritis is managed with short-term medication followed by balance exercises; Meniere's disease with salt restriction, medication and, in resistant cases, advanced therapies. For persistent unsteadiness, vestibular rehabilitation exercises are highly effective.
Frequently Asked Questions
What is vertigo and how is it different from dizziness?
Vertigo is the sensation that you or your surroundings are spinning, and it differs from light-headedness, unsteadiness or fainting. Because the body's balance centre lies in the inner ear, the most common source of true spinning is the ear.
What causes vertigo and dizziness?
The most frequent cause is BPPV (loose crystals), brief spinning attacks lasting seconds caused by displacement of microscopic crystals in the inner ear. Vestibular neuritis, Meniere's disease and vestibular migraine are other common causes.
When is vertigo an emergency?
Go to the emergency department if spinning comes with double vision, slurred speech, numbness or weakness of the face or arm, severe headache, or inability to walk, as these may indicate a stroke. Vertigo with sudden hearing loss also needs urgent treatment.
How is vertigo diagnosed?
The key is a detailed history; the duration, triggers and accompanying symptoms usually point to the diagnosis. Positional tests such as Dix-Hallpike are performed during the examination, with hearing tests and imaging added when needed.
How is BPPV (loose crystal) vertigo treated?
BPPV is treated not with drugs but with repositioning manoeuvres such as the Epley manoeuvre, where the crystals are guided back into place with specific head movements during the consultation. Most patients improve in the same session.
Would you like to book an appointment?
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