Vertigo is the sensation that a person or their surroundings are spinning or moving when no actual movement is occurring. This feeling is not the same as general dizziness or lightheadedness, but rather a specific illusion of motion that often causes nausea and imbalance. Since vertigo is a symptom of an underlying issue and not a diagnosis itself, finding the specific cause is the necessary first step toward treatment. Resolving vertigo involves navigating a series of medical specialists, as the origin can be located in the inner ear or the brain.
The Primary Care Triage
For most people, the journey toward a vertigo diagnosis begins with a Primary Care Physician (PCP) or General Practitioner. The PCP’s initial role is to perform a thorough screening and rule out common issues that mimic vertigo, such as dehydration, low blood pressure, or medication side effects. They take a detailed history of the symptoms, noting the frequency, duration, and any accompanying issues like hearing changes or headaches.
The primary care doctor also looks for signs that suggest a potentially serious or acute health issue, such as a stroke, which requires immediate emergency care. They may perform basic bedside physical tests, like checking for involuntary eye movements (nystagmus) or performing the Dix-Hallpike maneuver to identify the most common cause of vertigo. Based on this initial triage, the PCP determines if the case can be managed or if a referral to a specialist is necessary for a definitive diagnosis.
Otolaryngologists and Inner Ear Causes
The specialist most frequently involved in vertigo diagnosis is the Otolaryngologist, often called an ENT physician, who specializes in the ear, nose, and throat. These doctors focus on the inner ear, which houses the vestibular system—the main organ responsible for balance—and are the experts in diagnosing peripheral vertigo. Peripheral vertigo originates from a problem within this balance apparatus or the nerve connecting it to the brain and accounts for the majority of cases.
ENT specialists, particularly those with subspecialty training like Neuro-otologists or Otologists, diagnose conditions such as Benign Paroxysmal Positional Vertigo (BPPV), caused by dislodged calcium crystals. They also treat disorders like Meniere’s Disease, characterized by fluid buildup in the inner ear, and Vestibular Neuritis, an inflammation of the balance nerve. These physicians use specialized tests, including videonystagmography (VNG), to record eye movements and confirm inner ear function.
Neurologists and Central Vertigo
When vertigo symptoms suggest an origin outside the inner ear, a Neurologist is the appropriate specialist, as they focus on the central nervous system, including the brain and brainstem. Vertigo originating here is known as central vertigo and is significantly less common than the peripheral type. Neurologists investigate the brain’s ability to process and coordinate the balance signals it receives from the body.
A patient might be referred to a neurologist if their vertigo is accompanied by neurological symptoms such as severe, persistent headaches, double vision, slurred speech, or weakness in a limb. These accompanying signs can suggest a problem in the brainstem or cerebellum, the parts of the brain that control balance. Conditions investigated by a neurologist include:
- Migraine-associated vertigo
- Stroke
- Multiple sclerosis
- Tumors affecting the balance centers
Vestibular Rehabilitation Specialists
Once a diagnosis is made by an ENT or Neurologist, the physical management of vertigo often falls to a specialized Physical Therapist, known as a Vestibular Rehabilitation Specialist. These therapists administer Vestibular Rehabilitation Therapy (VRT), an exercise-based program designed to reduce dizziness and improve balance by retraining the brain. VRT helps the brain compensate for the abnormal signals it is receiving from the inner ear or central nervous system.
The therapy involves customized exercises, such as gaze stabilization and balance retraining, which encourage the coordination of input from the eyes, muscles, and the inner ear. For cases of BPPV, the specialist performs canalith repositioning procedures, such as the Epley maneuver, to shift the dislodged inner ear crystals back into their correct location.