Vertigo is one of the most disorienting and distressing symptoms a person can experience, and one of the most frequently misunderstood. Patients describe it as dizziness, but what they are actually experiencing is a false sensation of movement, either a feeling that the room is spinning around them, or that they themselves are spinning within a stationary room. This specific quality, the rotational illusion, is what distinguishes vertigo from general lightheadedness, presyncope, or the floating unsteadiness of anxiety. The distinction matters enormously for diagnosis and treatment, because most vertigo, even when it is frightening and disabling, has a specific and identifiable inner-ear cause that responds well to targeted management. As an ENT and Allergy Specialist who has completed specific training in vertigo and balance disorders, my approach to vertigo is to identify the specific inner-ear mechanism causing the symptom rather than treating the spinning sensation in isolation, because it is the mechanism that determines the treatment.
Why the Inner Ear Is Usually the Answer
The inner ear contains two functional systems: the cochlea, which processes sound and is responsible for hearing, and the vestibular system, which detects head movement and position and sends signals to the brain to maintain balance and spatial orientation. When the vestibular system on one side generates abnormal signals, either in excess or in deficiency relative to the other side, the brain receives mismatched information about the position and movement of the head, and the result is the spinning sensation of vertigo. The most common cause of vertigo that I see at Goutham Multispeciality Clinic is benign paroxysmal positional vertigo, or BPPV. In BPPV, tiny calcium carbonate crystals called otoliths, which normally sit in a specific structure of the vestibular system, become dislodged and migrate into one of the three semicircular canals. When the head is moved into certain positions, these displaced crystals create an abnormal fluid movement in the canal, generating a brief but intense burst of vertigo lasting typically seconds to a minute. BPPV produces classic position-triggered vertigo that is diagnosed at the bedside with specific positional tests and treated with canal repositioning manoeuvres in a single clinic visit in the majority of cases.
Assessment, Repositioning, and When Vertigo Needs Further Investigation
The ENT assessment of vertigo begins with a detailed history: when the spinning occurs, what triggers it, how long each episode lasts, whether it is associated with hearing changes or tinnitus, and whether there is any persistent imbalance between episodes. These features together point strongly toward the most likely diagnosis before any test is performed. For BPPV, the Dix-Hallpike manoeuvre, in which the head is moved into a specific position while I observe the eyes for the characteristic nystagmus (rapid, involuntary eye movement) that BPPV produces, confirms the diagnosis. The Epley repositioning manoeuvre, a series of specific head position changes performed in sequence, guides the displaced crystals back to their correct location and resolves symptoms in most patients at the first or second treatment session. Vestibular neuritis, another common ENT cause of vertigo, produces a more sustained episode of severe spinning lasting days, driven by inflammation of the vestibular nerve, and requires a different management approach. Meniere's disease, characterised by episodes of vertigo, fluctuating hearing loss, tinnitus, and ear fullness, requires further audiological and vestibular evaluation and long-term management. When vertigo is associated with neurological symptoms such as double vision, weakness, or difficulty walking, or when the onset is sudden and severe without a clear positional trigger, imaging is arranged to exclude a central nervous system cause. At Goutham Multispeciality Clinic, Bengaluru, most patients who come with positional vertigo leave with a diagnosis, a treatment, and a significant reduction in their spinning within the same appointment.
To book a consultation with Dr. Swathi N at Goutham Multispeciality Clinic, GM Palya, C V Raman Nagar, Bengaluru 560075 (Monday to Saturday, 12:00 PM to 2:00 PM and 6:00 PM to 8:30 PM), call +91 9945488546 or at Docube Clinic, HRBR Layout, Kalyan Nagar, Bengaluru (Monday to Saturday, 9:00 AM to 11:00 AM), call +91 7625068113.
Written by Dr. Swathi N, MBBS, DLO (Diploma in Otorhinolaryngology), AASC (Allergy Asthma Specialist Course, MedTrain), FAAI (Fellowship in Allergy, Asthma and Immunology, MedTrain), Vertigo and Balance Disorders Course (Annayya Healthcare), ENT and Allergy Specialist, Goutham Multispeciality Clinic, GM Palya, C V Raman Nagar, Bengaluru 560075 (Monday to Saturday, 12:00 PM to 2:00 PM and 6:00 PM to 8:30 PM, +91 9945488546), and Docube Clinic, HRBR Layout, Kalyan Nagar, Bengaluru 560043 (Monday to Saturday, 9:00 AM to 11:00 AM, +91 7625068113).
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