You know you rely on your ears to hear, but did you know you also rely on them to move? The inner ear contains the vestibular system, which helps your brain to understand where your body is in space in relation to all the things around it. This system provides that information to your brain so you can maintain your balance and steadiness as you move.
When there’s a problem with your inner ear, you can experience dizziness, which is a broad term that encompasses feeling unsteady, lightheaded or off-balance. You might also feel a very specific sensation known as vertigo.
“True vertigo has a sensation of motion,” says UNC Health audiologist Katie Roberts, AuD. “You feel like you’re spinning or the room is spinning. Some people describe a rocking sensation or a floating feeling.”
What causes this sensation, and how do you stop the spinning? Dr. Roberts explains.
Causes of Vertigo
The most common cause of the symptom of vertigo is a condition called benign paroxysmal positional vertigo, or BPPV.
“With the classic presentation of BPPV, you start with movement,” Dr. Roberts says. “Maybe you roll over or get out of bed or you move your head to look at an upper cabinet. The movement causes vertigo.”
The vertigo associated with BPPV typically lasts a minute or less, but it can be intense, even accompanied by nausea or vomiting. It improves when you stop moving. You might feel off-balance when you are able to move again.
BPPV is commonly diagnosed between the ages of 50 and 70, and once you’ve had one episode, you’re more likely to have another, Dr. Roberts says. It tends to be more common in women.
Your inner ear has tiny crystals called otoconia that are meant to stay in structures of the inner ear called the otolith organs. With BPPV, the crystals have moved out of those organs into one of the three canals of the inner ear. This movement, and the crystals swishing in the canal, makes you feel vertigo.
“The crystals are made from calcium carbonate, same as bone, and as we age, our bone density decreases, so one theory is that the crystals are not as strong in places as they used to be,” Dr. Roberts says, noting that the crystals may also move due to head trauma or for unknown reasons.
Another cause of vertigo is vestibular neuritis, a condition typically caused by a virus that results in an inflamed vestibular nerve, which connects the brain and the inner ear and sends communication to your brain about your balance.
“It’s a sudden experience—you’re hit with vertigo, severe nausea, and you can’t walk because of the severity of the dizziness,” Dr. Roberts says. “It can feel like a stroke, you’re so suddenly dizzy, and it can last for hours. If you have these symptoms, go to the emergency room or urgent care, because if that nerve is inflamed, you need steroid treatment and to rule out more serious conditions, such as a stroke.”
The nerve can become so damaged that it can’t be repaired, and signals won’t transmit from the inner ear to the brain.
Another explanation for vertigo could be Ménière’s disease, a rare disorder that also can cause tinnitus and hearing loss. There may be structural issues with the ear or ear infections that can lead to vertigo.
Less commonly, vertigo can be caused by an issue outside the ear, in the brain. Vertigo, trouble walking or loss of balance can be a sign of a stroke; other signs include sudden weakness on one side of the face, or in an arm or leg; difficulty speaking; blurred vision; and a sudden, severe headache. If you think could be having a stroke, or if vertigo doesn’t subside, seek emergency care. Migraines can cause vertigo, as can multiple sclerosis and brain injuries.
Diagnosing Vertigo
It can be difficult to distinguish between dizziness, which has a variety of causes, and vertigo.
“Dizziness as a symptom is really broad,” Dr. Roberts says. “You might be dizzy or lightheaded because of an issue with blood pressure or blood sugar.”
If you persistently feel dizzy or are having trouble with balance, talk to your primary care provider. Because balance is affected by the eyes, ears, muscles and joints, and your brain’s ability to send messages between them, an evaluation for dizziness or vertigo could take several steps. An audiologist can evaluate every part of your ear.
“We start with hearing tests to see if any other conditions could be causing the reaction,” Dr. Roberts says. “The ear does both hearing and balance, and issues with both can show up at the same time.”
You may be given balance tests and have air blown into your ears, which tricks your brain into thinking that you’re moving. Interestingly, your eyes are the window to your ears.
“There’s a reflex between the ear and the eye, so reading the eye movements can tell us how the ear is working,” Dr. Roberts says.
There’s also a specific test for BPPV; you lay on a table, and your provider moves your head and watches your eyes to check for placement of the crystals.
“The eyes tell me in which of the three inner ear canals the crystals are,” Dr. Roberts says.
Treating Vertigo
If you have BPPV, your provider can perform a repositioning maneuver, manipulating your head slowly to get the crystals to move back where they belong. The maneuver will vary depending on where the crystals have moved in the ear, but Dr. Roberts says it’s possible for your provider to teach you how to do these head movements yourself, at home.
If you had neuritis and your vestibular nerve was permanently damaged, vestibular physical therapy can help to retrain the brain to use the eye for balance. You may also benefit from physical therapy if you’re having ongoing issues with balance or walking.
Some people who regularly experience vertigo may benefit from carrying a motion sickness medication that can help with nausea when an episode occurs; talk to your doctor about this option.
Other causes of vertigo or dizziness may require a team approach for care.
“I don’t work in a silo,” Dr. Roberts says. “In addition to physical therapy, there may be an ear, nose and throat doctor for structural issues, or a neurologist for something like migraines. Your primary care provider may refer you to physical therapy to perform repositioning maneuvers and then refer to me if that’s not working.”
While there’s no way to completely prevent vertigo, regular exercise can help preserve your balance.
“Balance can be a use-it-or-lose-it system, and as we get older, we become less active,” Dr. Roberts says. “When you stay active and maintain your muscle strength, you’ll keep your inner ear stimulated and working.”
If you’ve been experiencing dizziness or balance issues, talk to your doctor. If you need a doctor, find one near you.