Vertigo is a symptom characterized by a sudden sensation that you or your surroundings are spinning or whirling. This feeling of false motion arises from a disruption in the body’s balance system, involving the inner ear, eyes, and brain. To determine the correct specialist, the underlying cause must be identified as either peripheral (inner ear-related) or central (brain-related). This distinction dictates the diagnostic and treatment path.
Starting the Diagnostic Process
The first point of contact for a new episode of vertigo is typically a Primary Care Physician (PCP) or General Practitioner (GP). The PCP performs an initial triage, taking a detailed medical history and reviewing current medications. They ask specific questions about the duration, frequency, and triggers of the spinning sensation to help distinguish the cause.
During the assessment, the doctor looks for “red flags” that might indicate a serious, central cause originating in the brain. These urgent signs include severe headache, double vision, slurred speech, or weakness in a limb, necessitating an immediate referral to the emergency department or a neurologist. For most cases, the PCP performs physical tests, such as the Dix-Hallpike maneuver, to check for involuntary eye movements (nystagmus) and determine if the issue is a common, peripheral problem. If the cause is not immediately apparent, the patient is directed to a specialist.
The ENT Specialist (Otolaryngologist)
An Otolaryngologist, commonly known as an ENT specialist, is the most appropriate expert when vertigo is suspected to be peripheral, originating in the inner ear or vestibular nerve. The inner ear contains the vestibular system, which controls balance and spatial orientation. ENT doctors have extensive knowledge of this system and are equipped to diagnose the majority of vertigo cases.
The conditions they manage include Benign Paroxysmal Positional Vertigo (BPPV), the most frequent cause, which occurs when calcium carbonate crystals become dislodged in the semicircular canals. They also treat Meniere’s Disease, characterized by vertigo, tinnitus, and hearing loss due to fluid buildup, and Labyrinthitis or Vestibular Neuritis, often caused by viral infections. The ENT specialist may use diagnostic tools, such as Videonystagmography (VNG) or Electronystagmography (ENG), to record eye movements and evaluate inner ear function. They may also conduct audiograms, since many inner ear balance disorders impact hearing.
The Neurologist
A Neurologist specializes in disorders of the central nervous system, including the brain, brainstem, and cerebellum, making them the appropriate specialist for central vertigo. Although central causes are less common, they are often associated with more severe or systemic conditions. The neurologist’s goal is to rule out life-threatening or chronic neurological diseases.
Conditions managed by a neurologist include vertigo caused by stroke, transient ischemic attacks (TIAs), or multiple sclerosis (MS), which affect the brain’s balance centers. They also treat vestibular migraine, a specific type of migraine that presents with recurrent vertigo episodes. The diagnostic process frequently involves advanced imaging, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans, to visualize the brain and rule out structural abnormalities. A detailed neurological examination assesses gait, coordination, and specific eye movements that point toward a central origin.
Vestibular Rehabilitation Experts
After a diagnosis is made, treatment often involves Vestibular Rehabilitation Therapy (VRT), administered by specialized Physical Therapists or Audiologists. VRT is an exercise-based program designed to promote the central nervous system’s ability to compensate for inner ear deficits. This process relies on neuroplasticity, allowing the brain to adapt and use other senses like vision and proprioception to regain stability.
For BPPV, therapists perform specific canalith repositioning procedures, such as the Epley Maneuver, which physically guide the dislodged inner ear crystals back to a place where they will not cause symptoms. For other forms of vertigo, VRT incorporates habituation exercises, involving repeated exposure to movements that trigger dizziness to reduce the brain’s sensitivity. Gaze stabilization and balance retraining exercises are also used to improve eye-movement control and overall steadiness, helping the patient reduce the risk of falls.