What Causes Vertigo? Symptoms and Treatment

Vertigo is a balance disorder where you feel as if you or your surroundings are constantly spinning, which can severely reduce your quality of life. Unlike simple lightheadedness or a brief blackout, true vertigo causes an intense illusion of movement and spinning. The most common cause of dizziness is an inner ear problem medically known as Benign Paroxysmal Positional Vertigo (BPPV), commonly referred to in daily life as "crystal displacement" or dislodged ear crystals.

In brief:

• Vertigo is not a disease on its own, but a symptom of another underlying health issue.
• The most common cause is the dislodgement of balance crystals in the inner ear.
• Nausea, vomiting, sweating, and involuntary eye movements (nystagmus) can accompany an attack.
• Special head maneuvers and hearing-balance tests are used for diagnosis.
• Most crystal displacement cases resolve within minutes through brief maneuvers performed by a physician.

What is Vertigo?

In the human body, balance is maintained by the brain processing signals from the inner ear, eyes, and muscle-joint system. The clearest answer to what vertigo is: a malfunction in this complex balance system causes the brain to create a false perception that you are moving when you are not. This usually occurs when the balance center in the inner ear, called the vestibular system, is affected.

During a true vertigo attack, a person struggles to stand, walk, or sometimes even turn over in bed. While this very common complaint can affect any age group, it is especially prevalent in adults over 40. A simple drop in blood pressure, or a feeling of lightheadedness from hunger or fatigue, should not be confused with true ENT (Ear, Nose, and Throat) vertigo cases. In true vertigo, there is a clear, severe sensation of the room spinning like a top, as if you have just stepped off a Ferris wheel at an amusement park.

Causes of Dizziness and Risk Factors

The underlying factors of dizziness are generally divided into two main groups: peripheral (inner ear-related) and central (brain-related). The vast majority of cases stem from inner ear problems.

Crystal Displacement (BPPV)

Our inner ear contains calcium carbonate crystals that help us perceive gravity and head position. When these crystals break loose from their sacs and escape into the semicircular canals, it is called crystal displacement. It is the most common cause of severe, sudden dizziness that usually lasts less than a minute, triggered by tossing in bed, looking up, or bending over.

Meniere's Disease

This is a condition characterized by an abnormal increase in fluid pressure in the inner ear. In Meniere's disease, dizziness is usually accompanied by ringing in the ears (tinnitus), a feeling of fullness, and fluctuating hearing loss. Attacks can last for hours and leave the person quite exhausted.

Vestibular Neuritis

This is the inflammation of the balance nerve (vestibular nerve) in the inner ear, typically following an upper respiratory tract infection. It causes severe dizziness, nausea, and vomiting that can last for days. Hearing loss is not seen, but the loss of balance is quite pronounced.

Central Causes

Conditions affecting the brainstem or cerebellum also lead to balance loss. Migraines, multiple sclerosis (MS), brain hemorrhage, stroke, or brain tumors are among the rarer but life-threatening central causes.

Vertigo Symptoms

When the balance system is affected, the body reacts in various ways. Although vertigo symptoms vary from person to person and depending on the underlying disease, some common complaints stand out during attacks. The severity of the symptoms can reach a level that completely restricts a person's daily life activities.

The most common symptoms include:

• A sensation that the person or the room is spinning violently
• Loss of balance, staggering while walking, or a tendency to fall
• Severe nausea and vomiting
• Cold sweating and pale skin
• Involuntary, rapid side-to-side or up-and-down twitching movements of the eyes (nystagmus)
• Ringing, buzzing, or a feeling of pressure in the ear
• Decreased hearing or extreme sensitivity to sound

In cases related to crystal displacement, symptoms are only triggered by head movements, whereas in conditions like vestibular neuritis, the severe spinning sensation can continue for days even if you do not move your head at all.

How is it Diagnosed at the Hospital?

For proper treatment, it must first be distinguished whether the source of the dizziness is the inner ear or a neurological issue. After listening to your medical history, your doctor will perform a detailed physical examination. Examining your eye movements is one of the most critical stages of the diagnosis.

When crystal displacement is suspected, a special test called the Dix-Hallpike maneuver is applied. In this test, while you are sitting on the examination table, the doctor turns your head at a specific angle, quickly lays you back, and observes the involuntary movements in your eyes (nystagmus). The direction of the eye movements shows exactly which canal the crystal has escaped into.

When necessary, advanced tests such as audiometry (hearing test) and VNG (Videonystagmography) are requested to measure your hearing level and inner ear functions. If your doctor suspects a central (brain-related) problem, they may resort to Brain MRI (Magnetic Resonance) or CT scans for detailed imaging.

Treatment Methods and Recovery Process

The treatment plan is shaped according to the underlying disease causing the dizziness. In BPPV (crystal displacement) cases, the most effective and fastest treatment method is repositioning maneuvers. With special head and body movements, such as the Epley maneuver applied by your doctor in the clinic, the dislodged crystals are guided back to where they belong. These maneuvers usually take a few minutes, and the majority of patients show dramatic improvement in a single session.

In conditions like Meniere's disease or vestibular neuritis, anti-nausea and balance-suppressing medications may be prescribed to reduce the severity of the attacks. However, since long-term use of these drugs can delay the brain's process of adapting to the loss of balance (compensation), they should only be used for the duration recommended by the physician.

To support the recovery process at home, it is beneficial to avoid sudden head movements, drink plenty of fluids, and stay away from stress. In chronic balance problems, special physical therapy exercises called vestibular rehabilitation greatly contribute to the brain relearning balance.

Complications and Risk Groups

Although dizziness itself usually does not pose a life-threatening risk, the loss of balance experienced during attacks can pave the way for serious injuries. Especially in older adults, hip fractures or head traumas due to falling during an attack are the most feared complications.

The constant fear of having an attack can lead to anxiety and depression. Patients may withdraw into themselves, hesitating to go out, drive, or enter social environments. A sudden attack while driving or operating dangerous machinery endangers the safety of both the person and those around them. Therefore, people with active complaints are advised to avoid driving until they are properly treated.

When to See a Doctor?

While most dizziness is inner-ear sourced and benign, in some cases, it can be a harbinger of serious neurological problems requiring emergency medical intervention. If you have new-onset dizziness of a severity you have never experienced before, you should definitely consult a healthcare facility.

If any of the following symptoms accompany your dizziness, you should call 112 without wasting time or go to the nearest emergency room:

• Drooping, sagging, or numbness on one side of the face
• Sudden loss of strength or a feeling of paralysis in the arms or legs
• Speech impairment, inability to find words, or slurred speech
• Double vision or loss of vision
• A severe, sudden headache of an unprecedented intensity
• Confusion or fainting

To learn more about managing emergencies, you can review our article titled When Should You Go to the Emergency Room?

The Process at BHT CLINIC İstanbul Tema Hastanesi

Proper expertise is of great importance in the diagnosis and treatment of balance problems and ear diseases. At the BHT CLINIC İstanbul Tema Hastanesi Ear, Nose, and Throat (ENT) Diseases department, comprehensive audiological and vestibular tests are performed with modern medical devices for our international patients presenting with dizziness complaints.

Our specialist physicians determine the source of your complaints and offer maneuver treatments, medication adjustments, or a multidisciplinary approach with the Neurology department when necessary. When you experience unexpected and severe attacks, our 24/7 emergency department and on-duty physician staff are always by your side. Bringing any previous hearing tests or MRI results with you when you come to our hospital will speed up the diagnostic process.

Frequently Asked Questions

Does crystal displacement resolve on its own?

Sometimes it can resolve spontaneously within weeks or months. However, since the person's quality of life drops significantly and the risk of falling increases during this period, it is much safer and more effective to treat it immediately with a short repositioning maneuver applied by a physician.

Do stress or fatigue cause vertigo?

Stress, insomnia, and extreme fatigue do not directly displace inner ear crystals, but they can trigger an existing balance problem or cause attacks to be felt more severely. Additionally, stress-induced neck tension can create a feeling of lightheadedness.

What should I do at home during an attack?

When dizziness begins, immediately sit or lie down in a safe place. Try to focus your eyes on a fixed point. Avoid sudden head movements and ensure the environment is dim and quiet. When your complaints subside, stand up slowly.

Does a neck hernia cause dizziness?

Neck calcification, hernias, or severe muscle spasms can affect the signals going from the neck to the brain, leading to a balance problem called cervical vertigo. However, this condition is more of a feeling of imbalance and lightheadedness rather than true vertigo where the surroundings spin violently.

Can vertigo be completely cured?

Depending on the underlying cause, it can largely be completely treated. BPPV (crystal displacement), in particular, heals rapidly with maneuvers. However, some inner ear disorders may tend to recur from time to time; in this case, following the lifestyle changes recommended by your physician reduces the frequency of attacks.

Don't let balance problems lower your quality of life. For an accurate diagnosis and a personalized treatment plan, you can book an appointment with our specialist physicians.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.