The experience of an illness can sometimes lead to lingering or unexpected health issues, particularly with the novel coronavirus. Vertigo, the sensation of spinning or whirling, is a disorienting symptom reported following SARS-CoV-2 infection. This balance disturbance can severely impact daily life, causing unsteadiness and a feeling of motion. Many patients who have recovered from the acute phase of COVID-19 report balance problems, prompting investigation into the virus’s long-term effects on the body’s equilibrium system.
The Confirmed Link Between COVID-19 and Balance Issues
Medical observations and large-scale studies have established a clear connection between COVID-19 infection and the onset of balance problems. Dizziness and vertigo are recognized clinical manifestations that occur both during the acute phase of the illness and as a persistent symptom of Long COVID. In patients hospitalized with the virus, dizziness was reported in nearly 19% of cases, demonstrating its inclusion among the neurological symptoms of the initial infection.
The prevalence is even more pronounced in individuals experiencing Post-Acute Sequelae of COVID-19 (Long COVID). Data suggest that 37% to 43% of these patients report persistent vertigo or dizziness symptoms. These figures confirm the virus’s impact extends beyond the respiratory system, affecting structures responsible for maintaining spatial orientation and stability. This evidence helps in understanding the mechanisms behind these lingering balance disturbances.
How the Virus Disrupts the Vestibular System
The mechanisms by which SARS-CoV-2 causes dizziness and vertigo are complex, involving direct damage to the balance apparatus and secondary systemic effects. One pathway involves the virus’s direct or immune-mediated impact on the vestibular system, the sensory system of the inner ear and brain. The virus can target cells expressing the Angiotensin-Converting Enzyme 2 (ACE2) receptor, which is present in tissues within the central nervous system and potentially the inner ear.
Invasion or the resulting intense inflammatory response (a cytokine storm) can trigger damage to the inner ear’s vestibular nerve, leading to a condition similar to vestibular neuritis. This neuro-inflammatory process disrupts the transmission of balance signals from the ear to the brain, manifesting as sudden, severe rotational vertigo. Additionally, the virus’s neurotropism allows it to infiltrate the central nervous system, where brainstem inflammation can interfere with regulating balance and the autonomic nervous system.
Secondary systemic effects also contribute to balance problems, particularly in Long COVID. Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction seen after COVID-19, where the nervous system fails to properly regulate heart rate and blood pressure upon standing. This autonomic dysregulation causes lightheadedness or orthostatic dizziness, often accompanied by a rapid increase in heart rate. The resulting dizziness is not true vertigo but rather a feeling of faintness or presyncope due to poor blood flow to the brain.
Recognizing Specific Symptoms of COVID-Related Dizziness
COVID-19 related balance problems can be categorized into distinct experiences that help determine the underlying cause. True rotational vertigo is characterized by the sensation that the world is spinning around the person or that the person is spinning internally. This symptom is often episodic and can suggest a peripheral issue, such as inflammation or damage to the inner ear’s vestibular nerve. It may be accompanied by nausea, hearing changes, or ringing in the ears.
Non-spinning dizziness is often described as lightheadedness, a floating sensation, or general unsteadiness, sometimes feeling “off-balanced” or “tipsy.” This non-rotational dizziness is linked to systemic issues like POTS, worsening when moving from sitting or lying to standing. It indicates that the body’s cardiovascular reflexes are not adapting appropriately to changes in posture.
Another distinct manifestation is Persistent Postural-Perceptual Dizziness (PPPD), a chronic condition identified in Long COVID patients. PPPD involves unsteadiness, non-spinning dizziness, or a feeling of rocking present on most days for three months or more. These symptoms are aggravated by an upright posture, active movement, or exposure to complex visual environments, such as a busy grocery store. Recognizing the specific nature of the dizziness is an important step toward receiving targeted care.
Medical Evaluation and Managing Recovery
Individuals experiencing sudden, severe vertigo or persistent balance problems should seek medical attention, especially if symptoms are accompanied by new hearing loss or facial weakness. A thorough medical evaluation is necessary to distinguish COVID-related balance issues from other potential neurological or inner ear conditions. This process typically involves a detailed medical history and physical examination, including specialized otologic and neurological assessments.
Diagnostic testing can include Videonystagmography (VNG), which tracks eye movements to evaluate the function of the inner ear and its connections to the brain. Audiometry may also be used to check hearing function, as the auditory and vestibular systems are anatomically linked. In cases where autonomic dysfunction is suspected, specific tests may be ordered to check for conditions like POTS.
The primary management strategy for most COVID-related balance disorders involves Vestibular Rehabilitation Therapy (VRT). VRT is an individualized exercise program designed to help the brain compensate for incorrect signals received from the damaged inner ear or nervous system. This therapy includes specialized exercises for gaze stabilization, balance retraining, and habituation to movements that provoke dizziness. While some patients may benefit from medication for symptomatic relief, VRT is the most effective long-term approach for restoring equilibrium and functional capacity.