What exactly is vertigo?

After you reach your 40s, it’s more common to sometimes feel lightheaded or like the room is spinning. In fact, after age 40, about one-third of people have these episodes. And they happen more often as people get older.¹

People sometimes think this spinning sensation is related to dizziness. It’s not. Dizziness is when you feel lightheaded, woozy or weak.² Feeling like you or the room around you is spinning is known as vertigo.

“Vertigo is defined as a hallucination of motion. For most people it is a spinning sensation,” says Eric Smouha, M.D. He’s an otologist and neurotologic surgeon – a specialized ear, nose and throat (ENT) doctor – at ENT and Allergy Associates in New York City.

Those sensations can make you feel like you’re losing your balance. And that makes it more likely that you’ll fall and possibly hurt yourself. Vertigo may also cause hearing loss.³ So, it’s important to get any symptoms checked out.

Here’s what else you need to know about vertigo, including how to treat it.

Is vertigo a disease?

No. Vertigo is a symptom of other health problems rather than a disease itself. “Most true vertigo results from a problem in the ear or the related connections in the nervous system,” says Dr. Smouha.

The inner ear not only helps you hear. It affects your balance too. Inside your inner ear are:

• Semicircular canals, called the vestibular labyrinth
• The vestibular nerve, a nerve that connects the inner ear to the brain

Let’s say something damages the inner ear or vestibular nerves. It can produce those spinning sensations that may make you feel like you’re going to fall.

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What causes vertigo?

There are 2 types of vertigo, and each has a different cause.^{3, 4}

• Peripheral vertigo is the most common type. It’s caused by a problem in the vestibular system in your inner ear. One kind of peripheral vertigo is triggered by a quick change in head position, such as when you roll over in bed or lean down to pick something up.
• Central vertigo is less common and is caused by a problem in the brain. It might be in the brain stem or the back part of the brain, called the cerebellum.

Causes of peripheral vertigo include:⁴

• Benign paroxysmal positional vertigo (BPPV). This is when pieces of calcium get dislodged and float inside the fluid-filled semicircular canals.⁵
• Certain medications, including chemotherapy drugs
• Inflammation or infections in the inner ear
• Noncancerous brain tumors that cause pressure on the nerves in the inner ear
• Ménière’s disease, which may be caused by too much fluid in the inner ear6
• Head injuries
• Migraines

Causes of central vertigo include:⁴

• Strokes
• Tumors (cancerous or benign)
• Multiple sclerosis
• Seizures

Symptoms of vertigo

The main ones: “Spinning, which may occur continuously or in episodes,” says Dr. Smouha. “There may also be hearing loss, usually in one ear, or tinnitus, or ringing in the ear,” he adds. This is especially common with Ménière’s disease.

Other symptoms include:³

• Dizziness
• Nausea or vomiting
• Balance issues or falls
• Motion sickness

How is vertigo diagnosed?

Vertigo is best diagnosed and treated by an ear, nose and throat doctor (ENT). These are medical doctors who specialize in conditions that deal with your head and neck.⁷ 

“People should see an ENT immediately for sudden hearing loss or sudden onset of vertigo,” Dr. Smouha notes.

An ENT will go over your medical history. They will do a physical exam and run some tests to check what’s causing the spinning sensation. “History is the most valuable,” Dr. Smouha explains.

An ENT will ask you:

• When you first experienced vertigo
• How long it lasted
• How often you have these spinning sensations

For example, maybe you tell your ENT that those spinning sensations are triggered by rolling in bed or tilting your head. And you also feel nauseous. In that case, they may diagnose you with BPPV.⁵

Or maybe the spinning sensation lasts for hours and you also have hearing loss and ringing in your ears. In that case, the cause could be Ménière’s disease.

An ENT will also do a physical exam. They want to see how well you can balance when you close your eyes and march in place, for example. Or when you stand with your feet together. If the ENT suspects a tumor may be causing vertigo, they might order imaging tests.

Can vertigo cause hearing loss?

Yes, says Dr. Smouha, but usually in one ear only. “A hearing exam will usually be done at the first visit to the ENT’s office,” he adds. Along with the other tests, the cause of the hearing loss and vertigo can be ruled out.

Sometimes the hearing loss is temporary, explains Dr. Smouha. “In Ménière’s disease the hearing loss may fluctuate at first and later may become permanent,” he adds.

If you’re having trouble hearing, you may want to consider getting a hearing aid. Your ENT may refer you to a hearing care professional, such as an audiologist. They can give you a comprehensive test and recommend a hearing aid that’s right for you.

How is vertigo treated?

Again, it depends on what’s causing the vertigo. But there are 3 main treatments:

• Repositioning maneuvers: Is the vertigo caused by calcium crystals? The ENT will show you certain exercises designed to get the crystals out of the semicircular canals and into the inner ear where they belong. These involve tilting your head to one side and then the other, for instance. Or repositioning your body. In about 80% of cases, these exercises work.⁸ Though you may have to do them several times, including at home.


• Medication: Sometimes a primary care provider will prescribe medications to help with vertigo, such as antihistamines and motion sickness drugs. These medicines are best for vertigo that comes on suddenly and doesn’t last long.³


• Physical therapy: People who suffer from dizziness or vertigo (or both) may benefit from a special type of physical therapy. It’s known as vestibular rehabilitation therapy. Depending on what the ENT prescribes, you might do exercises to:
  • Help control eye movement
  • Boost balance
  • Strengthen muscles
  These exercises can help lower the risk of falls and ease vertigo symptoms.⁹

In a few cases, people who have vertigo may need surgery. Sometimes it’s to remove a tumor. Other times, it’s to place a bone plug in the semicircular canal to stop symptoms. This is done if the repositioning exercises didn’t work.

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Sources

1. Balance system disorders American Speech-Language-Hearing Association. Accessed July 15, 2024.
2. Dizziness Mayo Clinic. Last reviewed December 3, 2022.
3. Vertigo Cleveland Clinic. Last reviewed May 9, 2023.
4. Vertigo-associated disorders National Library of Medicine: MedlinePlus. Last reviewed December 31, 2023.
5. Benign positional vertigo National Library of Medicine: MedlinePlus. Last reviewed August 28, 2023.
6. Meniere’s disease Mayo Clinic. Last updated January 3, 2024.
7. Otolaryngologist Cleveland Clinic. Last reviewed January 20, 2023.
8. Canalith repositioning procedure Cleveland Clinic. Last reviewed August 29, 2022.
9. Vestibular rehabilitation therapy Cleveland Clinic. Last reviewed October 16, 2022.

Information is for educational purposes only and is not a substitute for the advice of a licensed medical provider. Consult your provider prior to making changes to your lifestyle or health care routine.

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