Vertigo: Causes and Treatments

Learn about medical conditions that may cause vertigo

Close up portrait of a serious, thoughtful elderly man

Learn about medical conditions that may cause vertigo

by John Vaughan, Otolaryngologist


Who hasn’t experienced the strange sensation of the world suddenly spinning before their eyes? Sometimes it happens when you step off of an amusement park ride that had you going round in circles.


Or it may be triggered by something as simple as blowing your nose too hard. Without warning, everything seems to be moving, even though you’re standing perfectly still. It’s called vertigo, and it can last for several minutes or several hours.


Vertigo is related to balance and equilibrium, and is usually a telltale sign that something is amiss in the inner ear. Although this unpleasant spinning sensation may be triggered by a variety of causes, most cases stem from a handful of conditions.

Benign Positional Vertigo

Our ears are home to tiny crystals suspended in the inner ear canal. We’re not 100 percent sure what purpose these crystals serve, but we believe they help regulate our system of balance.


The inner ear has five areas of balance sensory input. Three of these are related to angular movement, while the other two affect horizontal (forward and reverse) and vertical (up and down) movement.


When the crystals in our ears are displaced, they can fall into one of the sensory input areas and trigger vertigo. This condition, called Benign Positional Vertigo (BPV), is one of the most common causes of vertigo.


Most BPV patients have had some kind of head injury or accident, such as whiplash, that throws the crystals out of position. For reasons we don’t yet understand, BPV also seems to occur in older patients who have no history of accident or injury.


In these cases, vertigo is usually related to changes in position. For example, a patient may roll over in bed and experience vertigo, but when he returns to the original position, the vertigo stops.

Diagnosing and treating BPV

We diagnose BPV through a comprehensive neurological test called an electronystagmogram (ENG). During an ENG, the patient sits in a reclining chair while electrodes are placed on his or her face and forehead to track and measure eye movement.


Then, we put the patient through a series of movements to detect abnormal responses and determine where the problem seems to be.


In addition, we place a tiny balloon filled with water into the ear canal. The temperature of the water in the balloon affects the temperature of the fluids in the inner ear and, subsequently, affects balance.


We vary the temperature of the water from cool to warm to determine the impact on the inner ear. This tells us if the inner ear systems are functioning properly. Often, patients will experience mild vertigo during this portion of the test, but the test itself is painless.

Vertigo and the Epley maneuver

In some cases, BPV may resolve on its own; if not, a technique known as the Epley maneuver successfully resolves vertigo in 90 to 95% of patients.


This treatment leads patients through a series of movements to reverse the actions that dislodged the crystals in the first place, and may be combined with an oscillator or vibrator to move the crystals back into their proper position.


Most patients are cured with just one session, although some may require two or three.

Vertigo and Meniere's Disease

Another common cause of vertigo is Meniere’s Disease. Typically affecting people in their 30s, 40s and 50s, this condition is characterized by three symptoms known as Meniere’s Triad.


The first of these is vertigo, which may be quite intense and last 30 minutes or more with nausea and vomiting. In addition, patients also experience hearing loss in the affected ear, and a ringing or buzzing sound known as tinnitus.


After the initial attack, hearing may come back and the patient may have no symptoms at all for a week or more; however, the symptoms will return.


We often treat Meniere’s Disease with dietary restrictions. We’ve found that a decreased intake of sodium may help reduce the fluid in the inner ear that seems to be causing the problem. Diuretic medications also may be effective.


Other patients may need surgery, which is highly effective if dietary changes do not help.

Other causes of vertigo

During flu season, we often see patients who recently had a bad case of cold or flu and, several weeks later, experience vertigo. This condition, called neuronitis, occurs when the virus that caused the illness affects the balance nerve. Virus medications or steroids usually help.


Finally, although rare, vertigo may also be caused by a tiny growth or tumor on the hearing or balance nerve. Such growths are found in just one out of 200,000 patients each year, and are usually treated with surgery to remove the growth.


This Scripps Health and Wellness information was provided by John Vaughan, MD, an otolaryngologist with Scripps Memorial Hospital La Jolla.