Specialties · Neurotology
Dizziness and vertigo: what each one is and how it is investigated
Dizziness is a broad term: it covers everything from a sense of unsteadiness to vertigo, in which the surroundings appear to spin. "Labyrinthitis" has become the popular name for almost all of it, but it describes a specific and uncommon inflammation. Identifying the type of dizziness is what directs testing and treatment.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
Dizziness, vertigo and labyrinthitis: what is the difference?
- Dizziness is the broad term. It includes light-headedness, unsteadiness, a sense of floating, and imbalance when walking.
- Vertigo is a specific type of dizziness: the sensation that the surroundings are spinning, or that the person is spinning within them.
- Labyrinthitis is inflammation of the labyrinth, the part of the inner ear responsible for balance. It usually comes with intense vertigo and hearing loss, and is far less frequent than common usage of the word suggests.
This distinction is not pedantry. Each group points to different causes.
What usually causes vertigo and dizziness?
| Cause | How it typically presents |
|---|---|
| BPPV | Brief, intense attacks on changing position, without hearing loss |
| Vestibular neuritis | Intense vertigo lasting hours or days, without hearing loss |
| Ménière’s disease | Attacks of vertigo with fluctuating hearing loss and tinnitus |
| Vestibular migraine | Dizziness associated with migraine, with or without headache in the attack |
| Non-otologic causes | Blood pressure drops, medications, neck problems, anxiety |
How is neurotologic assessment carried out?
The consultation is the most important part. The physician seeks to establish:
- Whether it spins, or whether it is unsteadiness.
- How long each episode lasts: seconds, minutes, hours, days.
- What triggers it: changing position, standing up quickly, head movement.
- Whether there is hearing loss, tinnitus or a sense of fullness in the ear.
- What medications the person takes.
During the consultation, specific manoeuvres are performed that reproduce the dizziness under controlled conditions while the eyes are observed. That involuntary eye movement, nystagmus, is what reveals which part of the system is involved.
The supporting tests:
- Audiometry and tympanometry — performed by the speech-language pathologists on our team.
- Videonystagmography — records eye movements under different stimuli and assesses the response of each labyrinth.
- vHIT — tests the response of each semicircular canal to rapid head movements.
- Cervical VEMP — assesses the saccule and the inferior vestibular nerve.
- Electrocochleography — supports investigation of endolymphatic hydrops, associated with Ménière’s disease.
- Posturography — measures how steady the person is standing and guides vestibular rehabilitation.
- Imaging, where the findings justify it.
What are the treatments?
Treatment follows the cause:
- BPPV — repositioning manoeuvres performed in the consulting room, returning the crystals to where they belong. Marked improvement within the first sessions is common.
- Vestibular neuritis — treatment of the acute phase followed by vestibular rehabilitation, a set of exercises that trains the brain to compensate for the deficit.
- Ménière’s disease — medical management of attacks and advice on diet and habits.
- Vestibular migraine — treatment of the migraine, alongside a neurologist where needed.
Medication for dizziness has its place during attacks, but taken continuously for months it interferes with the natural compensation of balance. Prolonged use without a diagnosis is a frequent problem.
When to seek emergency care
Dizziness accompanied by weakness or numbness on one side of the body, difficulty speaking, double vision, sudden severe headache, or sudden hearing loss should not wait for a scheduled appointment.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about neurotology
Are dizziness and labyrinthitis the same thing?
No. Dizziness is the symptom, and it has many causes. Labyrinthitis is inflammation of the labyrinth, the inner ear structure responsible for balance, and it is far less common than everyday use of the word suggests. Calling all dizziness labyrinthitis delays the correct diagnosis.
What is BPPV?
Benign paroxysmal positional vertigo. Small calcium crystals become displaced within the labyrinth and provoke brief, intense attacks of vertigo when the person changes position — lying down, turning in bed, looking up. It is the commonest cause of vertigo and usually responds to repositioning manoeuvres performed in the consulting room.
Which tests investigate dizziness?
It depends on the suspicion. Neurotologic assessment usually includes audiometry and tympanometry, balance tests such as videonystagmography, and specific manoeuvres performed during the consultation. Imaging is used where the findings justify it.
When is dizziness an emergency?
When it comes with weakness or numbness on one side of the body, difficulty speaking, double vision, a sudden severe headache, or sudden hearing loss. In these situations, seek emergency care rather than booking an appointment.
Is dizziness related to blood pressure or to the labyrinth?
It may relate to both, and to other things: inner ear disorders, migraine, medications, neck problems, anxiety, a drop in blood pressure on standing. This is why the consultation details the character of the dizziness before any testing — it is the history that separates the possibilities.