Vertigo, the dizzying sensation that feels like the world is spinning or tilting, is a common complaint prompting a doctor’s visit. It is not a diagnosis itself but a symptom, often signaling an issue within the inner ear or the brain’s balance centers. The causes of this spinning sensation are diverse, ranging from benign inner ear crystal displacement to serious neurological events. Finding the correct specialist is the first step toward relief due to the complexity of the condition.
Primary Medical Specialists
The initial diagnosis and management of vertigo are handled by physicians who focus on the body’s balance system. Otolaryngologists (ENT doctors) specialize in disorders affecting the inner ear, which houses the vestibular system responsible for balance. A subspecialty, Neuro-Otology, focuses specifically on complex balance issues, hearing loss, and diseases of the skull base, such as Meniere’s disease. These specialists treat common peripheral vertigo causes and can perform procedures like the Epley maneuver for Benign Paroxysmal Positional Vertigo (BPPV).
Neurologists specialize in conditions affecting the brain, spinal cord, and nervous system, addressing vertigo that originates centrally. Central vertigo arises from issues in the brainstem or cerebellum, and may be caused by vestibular migraines, stroke, or multiple sclerosis. The neurologist’s evaluation differentiates these central causes from peripheral ones, often involving detailed assessments of eye movements, coordination, and gait. A neurological consultation is warranted when symptoms include double vision, persistent unsteadiness unrelated to head position, or severe headaches.
Allied Health and Rehabilitation Experts
Beyond the diagnosing physicians, allied health professionals assist in the measurement and rehabilitation of balance disorders. Vestibular audiologists perform advanced diagnostic testing on the vestibular system and its connection to hearing function. They use specialized equipment to measure how the inner ear and brain process balance information and identify the location of any damage. This expertise in data interpretation is instrumental in confirming the diagnosis and guiding the treatment plan.
Vestibular physical therapists (VPTs) deliver physical recovery through Vestibular Rehabilitation Therapy (VRT). VRT is an exercise-based program tailored to encourage the brain to compensate for inner ear deficits or reposition dislodged inner ear crystals. Treatment techniques include habituation exercises to reduce sensitivity to dizziness, and gaze stabilization exercises to improve visual focus during head movement. VPTs also employ balance training to improve steadiness, reduce the risk of falls, and address the functional impact of vertigo.
Essential Diagnostic Testing
Specialized tests are required to pinpoint the exact location of the balance problem, directing treatment toward the inner ear or the central nervous system. Videonystagmography (VNG) and the older Electronystagmography (ENG) record eye movements during tracking visual targets and positional changes. VNG, which uses infrared video goggles, is common today and helps differentiate between peripheral and central causes of involuntary eye movements (nystagmus). A specific component of these tests is the caloric test, which stimulates the inner ear to measure the vestibular system’s response.
Rotary chair testing measures eye movements while the patient is seated in a motorized chair rotating at different speeds. This test provides information on the function of both inner ears together and is useful for detecting bilateral vestibular weakness. Computerized Dynamic Posturography (CDP) assesses how the visual, vestibular, and somatosensory systems work together to maintain balance. During CDP, the patient stands on a platform that moves, allowing measurement of postural sway and the body’s reliance on each sensory input.
Navigating the Referral Process
Specialized vertigo care often begins with a Primary Care Physician (PCP), who rules out common, non-vestibular causes like medication side effects or cardiovascular issues. If symptoms are persistent, recurrent, or accompanied by concerning signs like new hearing loss, the PCP acts as a gatekeeper for specialized referrals. For symptoms suggesting an inner ear origin, such as brief spinning episodes triggered by head position changes, a referral to an Otolaryngologist is the next step.
If the vertigo is spontaneous, constant, or associated with neurological signs, a referral to a Neurologist should be considered to investigate central causes. Once a specific vestibular diagnosis is confirmed, or if the primary complaint is imbalance and functional difficulty, the patient is frequently referred to a Vestibular Physical Therapist. Seeking out clinics that employ a multidisciplinary approach, often called “Balance Centers,” can streamline care. Finding a physical therapist specifically certified in vestibular rehabilitation can significantly improve recovery outcomes.