Vertigo, that unsettling sensation of the room spinning around you, affects roughly 40% of American adults at some point in their lives. While it often feels like a standalone problem, vertigo is usually a symptom of something else happening in your body, and certain warning signs, including hearing loss and ringing in the ears, should prompt you to see a doctor. Understanding what causes vertigo and when to seek help could prevent serious complications.

What Exactly Happens in Your Body During Vertigo?

Vertigo isn't simply dizziness. It's a specific sensation where you feel as though you or your surroundings are moving when they're actually stationary. "The sensation of movement or of surrounding objects moving when they are not" is how one expert describes it, and patients often report feeling as if the room is spinning.

The mechanism behind vertigo involves a complex communication system between your ear, brain, and eyes. "The inner ear is connected through the brain stem with nerves that direct eye motion," explained Hamid Djalilian, M.D., an otolaryngologist and neurotologist with UCI Health. "When the inner ear is stimulated abnormally, it sends a signal to the brain, and the brain interprets that as motion. The brain subsequently sends a signal, moving the eyes to adjust for that head motion. However, the brain realizes that motion has not occurred and then corrects that eye motion back. This can repeat a few times or many times. That movement of the eyes is what creates the sensation of motion to the patient".

"Usually, there is a stimulation of the inner ear balance organ that leads to it. It can also occur due to changes affecting the nerve centers for balance in the back part of the brain," said Hamid Djalilian, M.D.

Hamid Djalilian, M.D., Otolaryngologist and Neurotologist at UCI Health

What Symptoms Should Concern You Most?

While vertigo itself is the primary symptom, several accompanying signs warrant immediate medical attention. Beyond the spinning sensation, people experiencing vertigo may report nausea, vomiting, hearing loss, ringing in the ears, and trouble walking. Other symptoms include blurry vision, balance impairments, ear fullness, headaches, and lightheadedness.

The presence of hearing loss or ringing in the ears alongside vertigo is particularly significant because it suggests involvement of the inner ear, which controls both balance and hearing. This connection is why doctors emphasize the importance of reporting all symptoms together rather than treating them as separate issues.

When Should You See a Doctor About Vertigo?

Not all vertigo requires emergency care, but certain red flags demand prompt evaluation by a neurologist or ear, nose, and throat specialist. You should contact your healthcare provider if you experience any of the following symptoms alongside vertigo:

• Hearing Loss: A sudden or gradual decrease in your ability to hear, especially if it occurs with vertigo, may indicate inner ear involvement.
• Vision Loss: Changes in your eyesight accompanying dizziness could signal a neurological issue requiring specialist evaluation.
• Facial Drooping: Weakness or drooping on one side of your face is a potential sign of stroke or other serious neurological conditions.
• Speech Dysfunction: Difficulty speaking or slurred speech alongside vertigo warrants immediate medical attention.
• Loss of Consciousness: Fainting or losing consciousness during a vertigo episode is a medical emergency.
• Shortness of Breath: Breathing difficulties combined with vertigo may indicate a systemic problem.
• Chest Pain: Any chest discomfort during vertigo episodes should be evaluated immediately.
• Head Injury: Vertigo following a blow to the head requires prompt assessment.
• Seizures: Convulsions accompanying vertigo suggest a serious neurological condition.

Vertigo can also be a sign of more serious underlying conditions like tumors, acoustic neuromas, multiple sclerosis, head trauma, or Meniere's disease, which involves fluid buildup in the inner ear. These conditions require specialist evaluation to rule out.

What Are the Most Common Causes of Vertigo?

Understanding the root cause of your vertigo is essential for effective treatment. The most common causes include benign paroxysmal positional vertigo (BPPV), vestibulopathy, vestibular migraines, and inner ear infections.

Benign paroxysmal positional vertigo, or BPPV, is the most benign cause and occurs when calcium carbonate crystals in the inner ear, which help maintain balance, become displaced by certain head movements. BPPV most often occurs in people ages 50 and older and is most common in women. Vestibulopathy, on the other hand, is essentially a malfunction of the vestibular system in one ear, causing the brain to perceive head motion when it's not actually moving. Vertigo from vestibulopathy most often strikes during standing or movement rather than when sitting or lying down.

Vestibular migraines are a form of migraine that affects the inner ear and can cause short or long episodes of vertigo. Some patients with this type of migraine can experience vertigo for weeks or months at a time. Inner ear infections, or inflammation of parts of the inner ear, can very easily affect balance and therefore cause vertigo.

How to Manage Vertigo Based on Its Cause

• Epley Maneuver for BPPV: A common solution for benign paroxysmal positional vertigo involves the Epley maneuver, a professional and strategic repositioning of the head to return inner ear crystals to their rightful place for restored balance. In some cases, people can learn to safely perform these movements at home.
• Vestibular Rehabilitation for Vestibulopathy: This type of vertigo is treated with vestibular rehabilitation that helps the brain recognize it is receiving a faulty signal and adjust accordingly.
• Medications for Symptom Relief: Antihistamines are commonly used to help with dizziness and nausea, while antibiotics can be prescribed for bacterial inner ear infections.
• Comprehensive Approach for Vestibular Migraines: Treatment can involve using a combination of medications, supplements, and lifestyle changes to optimize sleep, diet, and reduce stress. This condition occurs more frequently around menopause, so some patients may need hormone replacement to help improve their symptoms.

The key to effective vertigo management is identifying its underlying cause. Because vertigo can lead to falls, accidents, and a decreased quality of life, speaking with your healthcare provider if you experience symptoms consistent with vertigo is essential. Don't dismiss vertigo as a minor inconvenience, especially if it's accompanied by hearing loss, ringing in the ears, or any of the other warning signs mentioned above. Early diagnosis and appropriate treatment can help you regain your balance and prevent serious complications.