Vertigo, the unsettling sensation that the world is spinning or tilting when you are still, can significantly disrupt your life. This intense dizziness can make everyday activities challenging and increase the risk of falls. If you’re experiencing these symptoms, you might be wondering, who diagnoses vertigo and what kind of medical professional can help you find relief.
At medical institutions like NYU Langone, experts understand the complexities of vertigo and offer comprehensive diagnostic approaches to pinpoint the cause of your symptoms and guide you towards effective management.
Vertigo arises when your body’s spatial orientation system malfunctions. This system, involving your inner ear, brain, and sensory pathways, usually works seamlessly to maintain balance. When disrupted, it can lead to episodes of vertigo that may be fleeting, or persist for weeks or even months. While vertigo sometimes resolves on its own, predicting its course is difficult, and in some cases, it can be persistent and require expert intervention.
If vertigo is so severe that it prevents you from standing for more than a few minutes, seeking immediate medical attention in the emergency room is crucial.
Types of Vertigo and the Specialists Who Diagnose Them
Diagnosing vertigo accurately begins with categorizing it into two main types: peripheral and central vertigo. Understanding these distinctions is key to determining who diagnoses vertigo and the appropriate specialist to consult.
Peripheral Vertigo: Diagnosed by ENT Doctors and Audiologists
Peripheral vertigo, the more common type, originates from issues within the inner ear or the vestibular nerve. This system, located in the inner ear, is crucial for balance and spatial orientation. Alongside dizziness, individuals with peripheral vertigo might also experience related symptoms like hearing loss or tinnitus, a ringing sensation in the ears.
Alt: Detailed anatomical illustration of the inner ear highlighting the vestibular system, crucial for balance and the origin of peripheral vertigo.
The most frequently encountered form of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). BPPV occurs when tiny calcium crystals in the inner ear, responsible for sensing head movement, become dislodged and move into the wrong part of the inner ear. This displacement causes the inner ear to send false signals to the brain, indicating movement when there is none. Specific head movements, like turning your head quickly, often trigger BPPV, leading to brief but intense vertigo episodes accompanied by nausea.
Other inner ear conditions that can cause peripheral vertigo and require diagnosis from specialists include:
- Ménière’s disease: A disorder affecting the inner ear’s fluid balance, leading to vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear.
- Labyrinthitis: Inflammation of the labyrinth, a part of the inner ear, usually caused by a viral infection, leading to sudden vertigo and sometimes hearing loss.
- Acoustic neuroma: Although rare, this noncancerous tumor on the vestibular nerve connecting the inner ear to the brain can also cause vertigo.
Certain medications known to be ototoxic, meaning they can damage the inner ear, can also induce vertigo. These include certain chemotherapy drugs, specific antibiotics, and loop diuretics. Even high doses of aspirin can sometimes trigger vertigo.
Who Diagnoses Peripheral Vertigo? Typically, an otolaryngologist (ENT doctor), often in conjunction with an audiologist, are the primary specialists who diagnose and manage peripheral vertigo. ENT doctors specialize in ear, nose, and throat disorders, including inner ear conditions, while audiologists are experts in hearing and balance disorders.
Central Vertigo: Diagnosed by Neurologists
Central vertigo, less prevalent than peripheral vertigo, stems from problems in the brain, specifically the brainstem or cerebellum. These brain regions are vital for coordinating balance and spatial awareness. Conditions affecting these areas can disrupt balance signals and lead to vertigo.
Causes of central vertigo can include:
- Concussion and Traumatic Brain Injury: Head injuries can damage the brain regions responsible for balance.
- Stroke: A stroke affecting the brainstem or cerebellum can disrupt balance pathways, causing sudden and severe vertigo.
- Migraines: Certain types of migraines, particularly vestibular migraines, can manifest with vertigo, even without a severe headache.
- Multiple Sclerosis (MS): This neurological condition can affect the brain and spinal cord, potentially leading to central vertigo.
Who Diagnoses Central Vertigo? If central vertigo is suspected, a neurologist, a specialist in disorders of the nervous system including the brain, is the appropriate medical professional to seek diagnosis and treatment from.
The Diagnostic Process: What to Expect
Regardless of whether your vertigo is suspected to be peripheral or central, the diagnostic process typically involves a comprehensive evaluation. When you ask, “who diagnoses vertigo,” understand that it’s often a team approach, particularly in larger medical centers.
Medical History: Your Symptom Story
The first step in diagnosing vertigo involves a detailed discussion of your medical history and symptoms. Your doctor will ask questions to understand:
- Nature of Dizziness: How would you describe the sensation? Is it spinning, tilting, or unsteadiness?
- Frequency and Duration: How often do episodes occur, and how long do they last?
- Triggers: Are there specific movements or situations that provoke your vertigo?
- Associated Symptoms: Do you experience hearing loss, tinnitus, nausea, or other symptoms along with dizziness?
- Family History: Is there a family history of balance or hearing disorders?
- Medical History: Have you had any recent infections, head injuries, or surgeries affecting the ear or brain?
Understanding how vertigo impacts your daily life is also crucial. Does it interfere with work, driving, or social activities? Vertigo can sometimes lead to anxiety, and discussing these emotional impacts is important for comprehensive care.
Physical and Neurological Exams: Assessing Balance and Function
A physical exam is essential to look for signs of the cause of vertigo. An otolaryngologist will examine your ears using specialized instruments to visualize the ear canal and eardrum.
Alt: ENT doctor carefully examining a patient’s ear canal using an otoscope, a key part of the physical examination for vertigo diagnosis.
Your doctor will also assess your balance and coordination, and observe your eye movements. Eye movements are closely linked to the vestibular system, and abnormal eye movements (nystagmus) can provide clues about the type and cause of vertigo. You might be asked to track a moving object to assess eye coordination and look for involuntary eye movements.
In cases where central vertigo is suspected, a more detailed neurological exam will be performed to assess reflexes, muscle strength, sensation, and coordination, helping to identify potential brain-related causes.
Hearing and Vestibular Tests: Pinpointing Inner Ear Issues
Audiologists play a vital role in diagnosing vertigo, particularly peripheral vertigo. They conduct a range of hearing and vestibular function tests to evaluate the inner ear and related pathways.
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Audiometry (Hearing Tests): These tests determine the extent and type of any hearing loss, which can be associated with inner ear disorders causing vertigo. Otoacoustic emissions testing, a specific type of hearing test, assesses the function of hair cells in the inner ear, which are crucial for hearing and balance.
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Videonystagmography (VNG): VNG is a key test for evaluating inner ear function. It uses infrared goggles to record eye movements in response to visual stimuli and changes in head position. Caloric testing, a part of VNG, involves gently stimulating the inner ear with warm or cold air to assess the vestibular system’s response and identify abnormalities causing vertigo.
Alt: Patient undergoing videonystagmography (VNG) testing, wearing infrared goggles that track eye movements to assess inner ear function and diagnose vertigo.
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Rotational Chair Testing: This test is used to further differentiate between peripheral and central vertigo. You are seated in a rotating chair while wearing goggles to track eye movements. The way your eyes move during rotation helps audiologists assess inner ear and brain function related to balance.
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Vestibular Evoked Myogenic Potentials (VEMP): VEMP testing measures the response of the vestibular system and neck muscles to sound stimuli, providing more detailed information about vestibular nerve function.
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Electrocochleography (ECochG): This test can help detect fluid buildup in the inner ear, which can be a factor in Ménière’s disease and related vertigo symptoms.
Imaging and Advanced Neurological Testing: Investigating Central Causes
In some cases, particularly when hearing loss is present alongside vertigo or central vertigo is suspected, further imaging studies may be necessary.
- MRI Scans: Magnetic Resonance Imaging (MRI) provides detailed images of the brain, inner ear, and surrounding structures. MRI can help identify structural abnormalities, tumors (like acoustic neuroma), inflammation, or evidence of stroke or MS that might be causing central vertigo.
If neurological causes are suspected, referral to a neurologist for further specialized testing and management is crucial. This may involve more detailed neurological exams, electroencephalography (EEG), or lumbar puncture (spinal tap) in specific cases.
Finding the Right Expert for Your Vertigo Diagnosis
When you’re experiencing vertigo, knowing who diagnoses vertigo is the first step toward finding relief. For most cases of vertigo, especially those suspected to be peripheral, starting with your primary care physician is a good initial step. They can then refer you to the appropriate specialist, most often an otolaryngologist (ENT doctor) or an audiologist for comprehensive evaluation and management. If your symptoms suggest central vertigo, your doctor may refer you to a neurologist.
By understanding the different types of vertigo and the specialists who are experts in diagnosing them, you can navigate your healthcare journey effectively and get the right help to address your dizziness and regain your balance.
