5 Reasons Your World is Spinning

Vertigo is the sensation that you or the world around you is spinning. GeorgePeters/Getty Images

Anyone who has ever experienced vertigo will likely never forget it. Vertigo is a sensation of spinning; that you or the room is turning. It can be very disorienting and cause the person experiencing it to fall, be nauseous, and/or vomit. Depending on the underlying cause, vertigo can last from a few seconds to a few hours. Here are 5 common causes of vertigo: 

Meniere's Disease 

Meniere's disease is a disorder of the inner ear and lymphatic system.

During an attack, which can last from 20 minutes to 4 hours, there are symptoms of vertigo, ear pressure or feeling of fullness, tinnitus, and hearing loss. People with Meniere's disease are free from symptoms between these attacks. Treatment is usually a low-salt diet, medications to treat symptoms, and in some cases, a device that delivers micro pressure therapy to the ear. In rare cases, surgical intervention is warranted. While the initial hearing loss associated with Meniere's disease can fluctuate, it usually progresses to a permanent hearing loss. Permanent hearing loss is successfully treated with hearing aids.  

Benign Paroxysmal Positional Vertigo (BPPV) 

BPPV is characterized by short bursts of vertigo (lasting less than one minute) following a change in head position. BPPV is more common in people over age 60 years and can be associated with head injuries; however, approximately 50% of cases are idiopathic (no known cause).

BPPV is caused when small crystals in the inner ear become dislodged and cause irritation in the semicircular canals. It is treated by specific physical therapy maneuvers to return those crystals to the correct place in the ear.  


Labyrinthitis refers to inflammation and/or infection of the labyrinth and both branches of the VIII cranial nerve.

"Labyrinth" is the term used to describe the cochlea and semicircular canals of the inner ear.  This disorder will impact both hearing and balance. Labyrinthitis can be caused by a bacterial or viral infection. Onset of symptoms is usually sudden and people with labyrinthitis may recover completely or have residual symptoms that become chronic. Medication is used to treat symptoms (such as vertigo and nausea), inflammation, and antibiotic or antiviral medications may be used to limit the course of illness. In cases of chronic imbalance, vestibular rehabilitation is recommended.

Vestibular Neuritis

Similar to labyrinthitis, vestibular neuritis can be caused by a bacterial or viral infection. The main difference is that hearing is not impacted with vestibular neuritis.

Central  Vertigo

“Central” refers to the brain. This type of vertigo usually originates in the brain stem or cerebellum. Some causes of central vertigo are migraine headache, stroke, and tumors.

In migraine-induced vertigo, it is interesting to note that a headache may not be present.

Symptoms that accompany vertigo may be light and/or sound sensitivity as well as gastrointestinal changes. If there is a family history of migraine headaches, vertigo seems to be more related to hormonal fluctuations, diet triggers, or sleep issues seem to cause vertigo, migraines should be ruled out.  This type of vertigo is treated by addressing migraine triggers with lifestyle changes and using migraine medications.  

A stroke can affect areas of the brain involved in vestibular function. In some cases, vertigo, nausea/vomiting, gait abnormalities, and difficulty with head motion may be the only initial symptoms. Sudden onset vertigo is a medical emergency and should be evaluated as soon as possible.  Bedside neurologic and vestibular assessments as well as imaging studies such as MRI are used to diagnose stroke. Vestibular rehabilitation may be necessary for complete resolution of vestibular symptoms post medical treatment.

In rare cases, a benign tumor can occur on the nerve between the inner ear to the brain. This slow-growing tumor is called an acoustic neuroma or vestibular schwannoma. The initial symptoms are usually hearing loss and tinnitus on the affected side, but vertigo occurs in approximately 20% of patients. Usually, the tumor progresses slowly enough that the vestibular system compensates for the decrease in function without causing vertigo. These tumors are usually dealt with by observation, surgery, or radiation. Treatment may affect or destroy the vestibular system on the side of the tumor so vestibular rehabilitation post treatment is very important.

There are many other causes of vertigo not mentioned here. If you experience vertigo, with or without hearing loss, it is important to seek medical evaluation and treatment. 


What is Meniere's Disease?(2015) American Academy of Otolaryngology - Head and Neck Surgery.   Accessed 07/08/2015 from http://www.entnet.org/content/menieres-disease

Labyrinthitis and Vestibular Neuritis: Infections of the Inner Ear (n.d.) Vestibular Disorders Association. Accessed 07/08/2015 from http://vestibular.org/labyrinthitis-and-vestibular-neuritis

Lempert, T., & Neuhauser, H. (2005). Migrainous vertigo. Neurologic Clinics, 23, 715-730.

Tehrani AS, Kattah JC, Mantokoudis G, Pula JH, et al. (2014) Small Strokes Causing Severe Vertigo. Neurology July 8, 2014 vol. 83 no. 2 169-173

Hain, TC (2015). Acoustic Neuroma. Accessed 07/08/2015 from http://www.dizziness-and-balance.com/disorders/tumors/acoustic_neuroma.htm


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