İşitmeAtölyesiAt a glance
The sensation that oneself or the surroundings are spinning/moving although there is no movement; a symptom, not a disease.
Spinning sensation, nausea-vomiting, imbalance, sometimes visual blurring (oscillopsia); in attacks or continuous.
EMERGENCY if accompanied by sudden severe headache, double vision, speech/strength loss (suspected central cause).
By cause: repositioning manoeuvres, medication, lifestyle; vestibular rehabilitation for persistent imbalance.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If dizziness is accompanied by sudden, severe headache, double vision, difficulty speaking/swallowing, weakness in the face or arm, or severe imbalance, these are ‘red flags’; go to the emergency department without losing time. If these signs are absent, most dizziness is inner-ear-related, benign and treatable.
Definition and epidemiology
Vertigo is the sensation that oneself or one’s surroundings are spinning/moving although there is no actual movement. Vertigo, which sits under the umbrella of ‘dizziness,’ must be distinguished from different experiences such as imbalance, presyncope and light-headedness (Bisdorff et al., 2009).
Dizziness and vertigo are very common; the lifetime prevalence is high and rises with age. They are reported more often in women and at older ages (Neuhauser, 2016).
Balance is maintained by integrating sensory information from the vestibular system in the inner ear, the eyes and the body (proprioception) in the brain. A problem in any of these systems can cause dizziness.
Symptoms and signs
Vertigo can occur with a spinning sensation, nausea-vomiting, imbalance and sometimes visual blurring (oscillopsia). Symptoms can be in attacks or continuous; they may be triggered by head movement or come on spontaneously.
The duration of the symptom guides the diagnosis: seconds-long, position-triggered dizziness suggests BPPV; attacks lasting minutes-hours suggest Ménière’s or vestibular migraine; continuous vertigo lasting days suggests vestibular neuritis or central causes.
Whether hearing loss, tinnitus or ear fullness accompanies it is also important in the differential diagnosis.
Causes and risk factors
Vertigo causes are basically divided into two: peripheral (inner-ear/vestibular-nerve origin) and central (brainstem/cerebellum origin). Peripheral causes are more common and usually benign.
The most common peripheral causes are BPPV, vestibular neuritis/labyrinthitis and Ménière’s disease. Vestibular migraine is both common and often overlooked. Central causes include stroke, migraine and, rarely, tumours.
Drugs, blood-pressure changes, anxiety disorders and vision problems can also contribute to dizziness. Advanced age, polypharmacy and a history of falls are risk factors.
Audiological and clinical assessment
The basis of assessment is a detailed history: the type, duration, triggers and accompanying symptoms of the dizziness largely guide the diagnosis. On examination, eye movements (nystagmus) and balance tests are examined.
- Positional tests (Dix-Hallpike, supine roll): the basis of BPPV diagnosis.
- vHIT and caloric test: assess the function of the semicircular canals.
- VEMP (cVEMP/oVEMP): examine the otolith organs and the branches of the vestibular nerve.
- Pure-tone/speech audiometry: reveals auditory involvement (e.g., Ménière’s, labyrinthitis).
- HINTS examination: valuable for distinguishing peripheral from central (stroke) in acute continuous vertigo.
In acute-onset continuous vertigo, excluding central causes is the priority.
| Attack duration | Trigger | Likely cause | Auditory symptom |
|---|---|---|---|
| Seconds | Change of position | BPPV | Usually none |
| Minutes-hours | Spontaneous/attack | Ménière’s, vestibular migraine | Present in Ménière’s, rare in VM |
| Days | Spontaneous, continuous | Vestibular neuritis/labyrinthitis | Present in labyrinthitis |
| Variable | Sudden + neurological sign | Central (stroke, etc.) | Variable — EMERGENCY |
Treatment and audiological rehabilitation
Treatment is determined by the underlying cause. Repositioning manoeuvres in BPPV; early mobilisation and, where needed, medication in vestibular neuritis; lifestyle and medical management in Ménière’s are applied.
Vestibular suppressant drugs provide short-term symptom control in the acute, severe period; however, long-term use is not recommended because it delays the brain’s adaptation (compensation) process.
Vestibular rehabilitation accelerates central compensation with adaptation, habituation and substitution exercises and is the most effective approach for persistent imbalance.
Impact on quality of life and advice
Dizziness can lower quality of life by causing fear of falling, anxiety and social withdrawal. The unpredictability of the symptoms can create a state of alertness in patients.
‘Red flags’ requiring emergency assessment: dizziness with sudden, severe headache, double vision, difficulty speaking/swallowing, weakness in the face or arm, severe imbalance. If these signs are present, go to the emergency department without delay.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Introduction to Vertigo and Balance Disorders. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vertigo-denge-bozukluklarina-giris/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/vertigo-denge-bozukluklarina-giris/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Bisdorff, A., Von Brevern, M., Lempert, T., & Newman-Toker, D. E. (2009). Classification of vestibular symptoms. Journal of Vestibular Research, 19(1-2), 1-13.
- Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y. H., & Newman-Toker, D. E. (2009). HINTS to diagnose stroke in the acute vestibular syndrome. Stroke, 40(11), 3504-3510.
- Neuhauser, H. K. (2016). The epidemiology of dizziness and vertigo. Handbook of Clinical Neurology, 137, 67-82.
Frequently asked questions
Is vertigo a disease?
No. Vertigo is a symptom; it is the feeling that the surroundings or you are spinning. Many different conditions can cause vertigo. What matters, therefore, is correctly identifying the cause underlying the dizziness.
Is every dizziness dangerous?
No. The great majority of dizziness stems from inner-ear-related, benign and treatable conditions. However, if it is accompanied by sudden, severe headache, double vision, difficulty speaking or weakness in an arm/leg, this requires emergency assessment.
How can I tell what’s causing my dizziness?
How long the dizziness lasts, what triggers it and whether hearing-related symptoms accompany it guide the diagnosis. For example, seconds-long dizziness when turning in bed and hours-long attacks point to different causes. A physician assessment is needed for a correct diagnosis.
Should I use dizziness medication all the time?
Dizziness-suppressing drugs are appropriate only in the acute, severe period, for short-term use. Long-term use delays the brain’s re-calibration of the balance system (compensation). For persistent balance problems, vestibular rehabilitation exercises are recommended instead of medication.
Do balance exercises work?
Yes. Vestibular rehabilitation provides marked improvement in many types of dizziness by supporting the brain’s re-learning of balance. Feeling mild dizziness during exercises is a sign that the system is working; it should therefore be continued regularly under expert guidance.
Scales that can be used to monitor the daily impact of dizziness and balance confidence: