Vertigo is the unsettling sensation of spinning or movement that occurs even when a person is standing still; it is a symptom of an underlying issue, not a disease itself. While a primary care physician can initiate the diagnostic process, an Otolaryngologist (ENT) is the specialist dedicated to disorders of the ear, nose, and throat, including the body’s balance mechanism. The ENT’s specialized knowledge of the inner ear makes them the authority for managing balance-related complaints. Their comprehensive approach involves advanced diagnostic testing and a range of medical, physical, and, in severe cases, surgical treatments.
The ENT’s Specialized Focus on Balance
Vertigo frequently originates in the vestibular system, which is housed deep within the inner ear. This system consists of the semicircular canals and the otolith organs, which work together to detect head movement and spatial orientation. When this intricate system malfunctions, the conflicting signals sent to the brain result in the sensation of vertigo. ENTs have a deep understanding of common conditions like Benign Paroxysmal Positional Vertigo (BPPV), which involves displaced calcium crystals, and Meniere’s disease, linked to fluid pressure changes in the inner ear. They also treat inflammatory conditions of the balance and hearing nerves, such as vestibular neuritis and labyrinthitis. This specialized focus enables the ENT to determine if the vertigo is peripheral—originating in the inner ear—or central, stemming from the brain.
Comprehensive Diagnostic Testing
An ENT utilizes specialized tools to precisely identify the source of the vertigo, as a general physical exam is often insufficient. Diagnostic procedures focus on evaluating the vestibulo-ocular reflex and identifying involuntary eye movements (nystagmus).
Videonystagmography (VNG)
VNG or Electronystagmography (ENG) records eye movements to evaluate the function of the vestibulo-ocular reflex. During VNG, the patient wears specialized goggles to track nystagmus, which indicates which part of the inner ear is affected.
Caloric Testing
Caloric Testing is a component of VNG where warm and cold air or water is introduced into the ear canal. This stimulation mimics movement in the inner ear’s horizontal canal, and the resulting eye movements are recorded to assess the balance nerve’s responsiveness.
Rotational Chair Testing
Rotational Chair Testing provides a controlled assessment by placing the patient in a motorized chair that rotates slowly. This allows the ENT to analyze eye movements relative to the controlled motion.
Audiometry
Since the auditory and balance systems share the same nerve pathway, Audiometry (a hearing test) is often performed. Checking for concurrent hearing loss helps differentiate between various inner ear disorders.
Medical and Physical Therapy Treatments
Treatment for vertigo usually begins with non-invasive methods managed by the ENT, as surgery is rarely required. Pharmacological management often includes vestibular suppressants, such as meclizine, to reduce the immediate sensation of spinning, and anti-nausea medications for accompanying symptoms. For Meniere’s disease, the ENT may prescribe diuretics in combination with a low-salt diet to help reduce excessive fluid pressure within the inner ear.
A highly effective physical therapy intervention is the Canalith Repositioning Procedure (CRP), such as the Epley or Semont maneuver, used to treat BPPV. This procedure involves a specific sequence of head and body movements designed to physically move the dislodged calcium carbonate crystals out of the sensitive semicircular canals. The ENT or a trained therapist performs or teaches these maneuvers, which often provide immediate relief after one or two sessions. If inner ear damage is present, the ENT may refer the patient to Vestibular Rehabilitation Therapy (VRT). VRT is a specialized form of physical therapy that uses habituation and balance exercises to help the brain compensate for faulty signals, retraining the central nervous system to rely more on visual and somatosensory cues for balance.
Surgical Options for Severe Vertigo
When conservative treatments fail to control severe, persistent vertigo that significantly impairs a patient’s daily life, an ENT may consider surgical intervention. These procedures are reserved for intractable cases, such as debilitating Meniere’s disease or rare structural abnormalities.
Vestibular Nerve Section
This procedure involves cutting the balance portion of the vestibulocochlear nerve to stop the transmission of faulty signals from the inner ear to the brain. It often controls vertigo while preserving the patient’s hearing.
Labyrinthectomy
A Labyrinthectomy is a more destructive option where the inner ear’s balance organ is removed or disabled to eliminate the source of the vertigo. This is only considered when the affected ear has already experienced a complete or near-complete loss of hearing, as the procedure results in total deafness in that ear.
Endolymphatic Sac Procedures
For Meniere’s disease, these procedures are sometimes performed to decompress or shunt the endolymphatic sac, aiming to regulate the fluid pressure within the inner ear. These surgical approaches represent a final step when all other medical and rehabilitative efforts have been exhausted.