Vertigo is the sensation that you or your surroundings are spinning or moving, even when you are standing still. This false sense of motion is not the same as general lightheadedness, and it often stems from issues in the inner ear or the brain. Because the causes of this spinning sensation are varied and can originate in different body systems, determining the right specialist to consult can be a confusing first step. Knowing the path to an accurate diagnosis is the first step toward effective treatment.
First Steps Who to See Initially
The initial evaluation for vertigo almost always begins with a Primary Care Provider (PCP) or General Practitioner (GP). Your PCP will take a detailed medical history and perform a basic physical exam to distinguish between benign causes and more serious conditions. This initial screening often includes checking your vital signs, testing your gait or walking stability, and observing your eye movements, which helps to classify the vertigo as peripheral (inner ear) or central (brain-related).
If your vertigo is sudden and severe and is accompanied by neurological symptoms, seek emergency care immediately. These red flag indicators include a sudden, severe headache, double vision, slurred speech, weakness or numbness in one arm or leg, or an inability to walk without severe assistance. These symptoms can suggest a stroke or other central nervous system event that requires urgent intervention.
The Two Primary Diagnostic Specialists
After initial screening, your PCP will typically refer you to one of two specialists. The distinction between these two systems is fundamental to finding the root cause of the spinning sensation. The two primary diagnostic specialists are the otolaryngologist and the neurologist.
The otolaryngologist, often referred to as an ENT doctor, specializes in disorders of the ear, nose, and throat, focusing particularly on the inner ear’s vestibular system. They treat peripheral vertigo, which is the most common form and results from problems in the inner ear or the vestibular nerve. Common conditions they manage include Benign Paroxysmal Positional Vertigo (BPPV), caused by dislodged calcium crystals in the inner ear canals, or Meniere’s disease, which involves a buildup of fluid pressure in the inner ear. Some ENTs pursue additional fellowship training to become neurotologists, specializing in complex inner ear and skull base disorders that affect both hearing and balance.
The neurologist specializes in the central nervous system, including the brain, spinal cord, and nerves. They investigate central vertigo, which is a less common but often more serious form caused by issues affecting the balance centers in the brainstem or cerebellum. Conditions such as stroke, multiple sclerosis, brain tumors, or certain types of migraine-associated vertigo fall under their expertise. The initial assessment by the PCP guides the referral to either the ENT or the neurologist.
Treatment Through Vestibular Rehabilitation
Once a diagnosis is made by the ENT or neurologist, the next phase often involves a specialized form of therapy known as Vestibular Rehabilitation. This treatment is typically provided by Vestibular Rehabilitation Therapists (VRTs), who are specialized Physical Therapists (PTs) or Occupational Therapists (OTs). Their goal is to help the brain compensate for the abnormal signals it receives from the damaged inner ear or central balance system.
A VRT customizes an exercise program to retrain the body’s balance mechanisms, including the use of vision and touch. These programs often include gaze stabilization exercises, which help the eyes remain fixed on an object while the head is moving, and habituation exercises, which involve repeated exposure to movements that provoke mild dizziness to allow the brain to adjust. For BPPV, VRTs use specific head and body movements, such as the Epley maneuver, to physically reposition the displaced inner ear crystals.
Audiologists also play an important supporting role in the diagnostic and treatment process. While they are specialists in hearing disorders, they perform specific balance tests, such as videonystagmography (VNG) or vestibular evoked myogenic potentials (VEMP). This information is valuable for confirming the precise location and nature of the balance problem, which in turn helps guide the VRT’s rehabilitation plan.