Vertigo is the sudden sensation that you or your surroundings are spinning or whirling. This feeling of false motion is typically a symptom of a problem within the body’s balance system, which is centered in the inner ear. An otolaryngologist, commonly known as an ENT specialist, focuses on disorders of the ear, nose, and throat. Since the inner ear houses the primary control center for balance, an ENT can definitively help manage vertigo.
The Inner Ear Connection
The inner ear is a complex structure serving two connected sensory functions: hearing and balance. The hearing portion is the cochlea, while the balance mechanism is the vestibular system. This system is composed of the semicircular canals and the otolith organs, which detect head movement and gravity.
The vestibular system senses motion through fluid and tiny hair-like sensors within the three semicircular canals. These canals detect movement along three different planes: up-and-down, side-to-side, and tilting. When the head moves, the fluid shifts, bending the hair cells and sending signals via the vestibular nerve to the brain. The brain uses this information to maintain posture and keep vision steady, so a malfunction in this system is why an ENT specialist is the appropriate doctor to consult.
Common Inner Ear Conditions Causing Vertigo
The most frequent cause of vertigo originating in the inner ear is Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when tiny calcium carbonate crystals, called otoconia, become dislodged and migrate into one of the semicircular canals. When the head changes position, these displaced crystals improperly move the fluid, sending false spinning signals to the brain that result in brief, sudden episodes of vertigo.
Another common cause is Ménière’s disease, characterized by an abnormal buildup of fluid (endolymph) in the inner ear. This fluid imbalance leads to recurring attacks of vertigo, fluctuating hearing loss, tinnitus (ringing in the ear), and a feeling of fullness. Vestibular neuritis and labyrinthitis are related conditions, typically triggered by a viral infection causing inflammation. Vestibular neuritis involves inflammation of the vestibular nerve, causing prolonged, severe vertigo without affecting hearing. Labyrinthitis is a more extensive inflammation of the inner ear labyrinth, resulting in both vertigo and hearing changes.
Diagnostic Procedures Performed by ENTs
Determining the cause of vertigo begins with a detailed clinical history and physical examination. A key component involves positional testing to observe involuntary eye movements, known as nystagmus, as the head is moved. The Dix-Hallpike maneuver is the standard test for diagnosing BPPV, involving rapidly moving the patient from a seated to a reclined position while watching for vertigo and nystagmus.
ENTs also employ specialized equipment to objectively measure vestibular system function. Videonystagmography (VNG) or Electronystagmography (ENG) uses goggles to record eye movements during various tasks to evaluate balance pathways. Since some inner ear conditions affect both hearing and balance, an audiometry test is often necessary to check for hearing loss. These test results help the ENT pinpoint the exact location and nature of the inner ear dysfunction.
Treatment Strategies Managed by the ENT
Treatment for vertigo is tailored to the specific diagnosis, and ENTs often provide effective relief for common forms. For BPPV, the primary intervention is a series of in-office physical techniques called canalith repositioning maneuvers. The most well-known is the Epley maneuver, which uses a specific sequence of head and body movements. This maneuver uses gravity to guide the misplaced otoconia out of the semicircular canal and back into a harmless area of the inner ear.
Medical management is utilized for acute symptoms or chronic conditions. Vestibular suppressants, such as antihistamines or benzodiazepines, may be prescribed briefly to reduce acute vertigo and nausea. For Meniere’s disease, the ENT may recommend a low-salt diet and diuretics to manage inner ear fluid volume, while vestibular neuritis may be treated with steroids. If symptoms persist, the ENT coordinates care with a physical therapist specializing in Vestibular Rehabilitation Therapy (VRT). VRT is an exercise-based program that helps the brain compensate for abnormal inner ear signals, retraining the balance system for long-term stability.