Vertigo is the sensation of spinning or a false sense of movement, distinct from general dizziness or lightheadedness. It involves the illusion that the environment or the person themselves is rotating. Since the most common causes of vertigo originate in the inner ear, an Otolaryngologist, or ENT specialist, is the most appropriate medical professional for diagnosis and management. The ENT specializes in disorders of the ear, nose, and throat, including the complex system responsible for maintaining the body’s equilibrium.
The Inner Ear Connection to Balance
The inner ear contains the vestibular system, which works alongside vision and proprioception to govern balance and spatial orientation. This system resides within the bony labyrinth and is composed of the semicircular canals and the otolith organs. The three semicircular canals detect rotational movements of the head. They are filled with endolymph fluid, which shifts during movement and stimulates hair cells that send signals to the brain.
The otolith organs (the utricle and saccule) detect linear acceleration and head position relative to gravity. These organs contain small calcium carbonate crystals, or otoconia, which move in response to motion. When the vestibular system malfunctions, conflicting signals sent to the brain cause vertigo. As experts in the anatomy and physiology of the inner ear, ENT specialists are uniquely positioned to address these balance disturbances.
Specific Vertigo Conditions Managed by ENTs
Most forms of vertigo are peripheral, meaning the cause lies within the inner ear or the vestibular nerve. Benign Paroxysmal Positional Vertigo (BPPV) is the most frequently diagnosed cause, involving brief, intense spinning sensations triggered by head position changes. BPPV occurs when otoconia become dislodged from the utricle and migrate into a semicircular canal, disrupting the fluid dynamics.
Meniere’s disease is characterized by episodes of vertigo lasting hours, accompanied by fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. This chronic disorder is caused by an abnormal accumulation of endolymph fluid within the inner ear. Other common inner ear causes include Vestibular Neuritis, inflammation of the vestibular nerve causing severe vertigo without hearing loss, and Labyrinthitis, inflammation affecting both balance and hearing, often following a viral infection.
Otolaryngology Diagnostic and Therapeutic Procedures
The ENT specialist employs specific tests to pinpoint the location and cause of vertigo. Diagnostic procedures include Videonystagmography (VNG) or Electronystagmography (ENG), which record involuntary eye movements (nystagmus). This is done while the inner ear is stimulated or the patient’s head is positioned in various ways. The pattern of nystagmus helps differentiate between an inner ear cause and a central, or brain-related, cause.
The Dix-Hallpike maneuver is a positional test used to reproduce BPPV symptoms by moving the patient rapidly from sitting to lying with the head turned. Audiometry, or a hearing test, is also performed to check for associated hearing loss. This helps diagnose conditions like Meniere’s disease or Labyrinthitis, allowing the ENT to formulate a targeted treatment plan.
Treatment for BPPV involves Canalith Repositioning Procedures (CRPs), such as the Epley maneuver. This series of head and body movements uses gravity to guide the misplaced otoconia out of the semicircular canal and back into the utricle. For other inner ear disorders, the ENT may prescribe medication, such as anti-vertigo drugs or diuretics and a low-salt diet for Meniere’s disease. Steroid injections may also be administered to reduce inflammation in cases like Labyrinthitis.
ENTs frequently refer patients to Vestibular Rehabilitation Therapy (VRT), a form of physical therapy that retrains the brain to compensate for abnormal inner ear signals. In rare cases where conservative treatments fail, surgical options, such as a posterior canal occlusion, may be considered.
When to Seek Neurological or Other Care
Although ENTs manage most vertigo cases, certain symptoms suggest the cause may be central, originating in the brain or central nervous system. These “red flag” symptoms require immediate attention from a neurologist or the emergency department. Central vertigo may indicate a serious neurological event, such as a stroke, if it occurs alongside a sudden, severe headache, double vision (diplopia), or slurred speech (dysarthria).
Other concerning signs include profound weakness or numbness in the limbs, difficulty walking (ataxia) disproportionate to the spinning sensation, or any loss of consciousness. These symptoms point toward problems in the brainstem or cerebellum, which process balance information. If these neurological symptoms accompany vertigo, the ENT specialist will refer the patient for evaluation by a neurologist, who can investigate conditions like vestibular migraine or central nervous system disorders.