TürkçePatients often wonder whether sudden dizziness occurring during the day could be vertigo. Dizziness may have many different causes, but recurrent complaints associated with position may indicate vertigo. The important point that should not be overlooked is that vertigo is not a disease but the symptom of dizziness itself. Therefore, the essential step is to diagnose the underlying cause.
The question of what causes sudden dizziness is important for reaching the correct diagnosis. Displacement of inner ear crystals, inflammation of the vestibular nerve, migraine, and circulatory disorders are among the main causes.
The question of how the differential diagnosis of vertigo is made is important for preventing misdiagnosis. The patient’s history, physical examination, and vestibular tests when necessary are evaluated. This process helps exclude other causes of dizziness.
The question of what people experiencing sudden dizziness should do plays a critical role in daily life safety. Patients should rest, avoid sudden movements, and seek specialist advice if their complaints recur. In this way, possible complications may be prevented.
What Is the Difference Between Dizziness (Vertigo) and a Feeling of Imbalance (Dizziness)?
Vertigo and imbalance are two conditions that are often confused. Both involve loss of balance. However, vertigo is characterized by an active spinning sensation of the surroundings, whereas imbalance is characterized by harder-to-describe sensations such as feeling suspended in space, the ground slipping from beneath the feet, and lightheadedness.
Vertigo and imbalance may result from various factors:
- Sudden changes in blood pressure
- Dehydration
- Low blood sugar
These factors may cause mild or severe dizziness and a feeling of imbalance. However, they generally do not indicate an inner ear problem. These complaints may particularly occur after standing for a long time.
On the other hand, when dizziness (vertigo) originates from the inner ear, it is much more severe and distressing. It results from dysfunction of the vestibular system located in the inner ear. In this condition, the individual feels that they or their surroundings are spinning. It becomes particularly noticeable when the head moves and is associated with the following conditions:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Labyrinthitis
- Vestibular neuritis
- Ménière’s Disease
Vertigo occurs when there is a conflict between signals from the inner ear and the brain. This condition causes impairment in the person’s orientation, navigation skills, and therefore balance control. Individuals experiencing vertigo often have difficulty because they feel that their surroundings are spinning, and this may affect their daily activities.
What Are the Common Inner Ear-Related Causes of Vertigo?
Some fundamental disorders are among the common inner ear-related causes of vertigo. These usually occur as a result of structural changes or functional disorders in the inner ear.
First, Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vertigo and may be triggered by changes in head position. This condition occurs when small calcium crystals in the inner ear become displaced. The crystals enter the semicircular canals and disrupt the perception of movement. It has several variants. It is completely treatable. Therefore, people experiencing severe or recurrent dizziness are advised to consult a healthcare institution. In this way, an accurate diagnosis can be made and an effective treatment plan can be prepared.
Ménière’s disease is a more complex condition. Ménière’s disease is associated with abnormal fluid accumulation in the inner ear. Auditory symptoms may also accompany it. It must be documented very carefully, especially when fullness in the ear and fluctuating hearing loss, with hearing decreasing and then improving from time to time, are present. It is not a condition that can be diagnosed based only on the patient’s history before completing differential diagnostic tests. Because it is a chronic disease, regular follow-up, lifestyle changes, and vestibular rehabilitation are essential.
Vestibular neuritis is a condition characterized by severe dizziness that develops after viral infections. It is characterized by acute-onset severe vertigo resulting from inflammation of the vestibular nerve. It may resolve spontaneously even without intervention. The most important point in vestibular neuritis is to begin vestibular rehabilitation promptly. Otherwise, permanent impairment of balance nerve functions may occur. Even if a person who has experienced vestibular neuritis believes they have recovered, they may still have significant loss of balance function.
Who Has a Higher Risk of Experiencing Vertigo?
Vertigo is a symptom that affects an individual’s balance and causes the surroundings or the person themselves to be perceived as spinning. The underlying problem causing this symptom must be identified. Certain groups are particularly more susceptible to this condition. In older adults, age-related changes or deterioration in the vestibular system increase the risk of vertigo as a natural consequence of aging. This group also tends to have other health problems such as cardiovascular conditions, which may contribute to vertigo. Precautions against falls must be taken in this age group.
People with a history of dizziness are more likely to experience recurrent vertigo attacks. Benign paroxysmal positional vertigo (BPPV), which is triggered by displacement of calcium crystals in the inner ear, is particularly more common in these individuals.
Certain existing medical conditions also affect the risk of vertigo:
- Neurological conditions such as migraine, stroke, and multiple sclerosis impair brain functions and balance mechanisms.
- Cardiovascular problems may cause dizziness by restricting blood flow to the brain, particularly in older adults.
Lifestyle factors should also be considered:
- Dehydration: Disrupts balance and may contribute to vertigo.
- Alcohol consumption: Disrupts fluid balance in the inner ear and causes dizziness.
How Is Vertigo Diagnosed?
Vertigo is definitely a symptom indicating that another underlying problem is present. Therefore, diagnosing the underlying cause begins with taking a detailed patient history focused on factors such as the onset time, duration, triggers, and accompanying symptoms of the dizziness. A neurological examination is then performed to exclude central nervous system problems that may cause vertigo and similar symptoms. Some tests used during the diagnostic process include:
- Romberg Test: The patient stands with the feet together, arms at the sides, and eyes closed. If the patient sways or falls, this indicates a problem with the balance mechanism.
- Nystagmus test: Determines whether spontaneous involuntary jerking eye movements are present.
- Head Impulse Test (HIT): The head is turned rapidly while the patient looks at a fixed point. The eyes lagging behind and making corrective movements indicate impaired vestibulo-ocular reflex function.
- Test of Skew: This test is performed by covering one eye. It evaluates whether vertical misalignment occurs when the eye is covered.
These three tests are known as bedside tests and are performed on all patients with dizziness in emergency departments. These are highly specific tests used to determine whether the dizziness originates from the ear or is neurological.
Following these examinations, Vestibular Function Tests are performed. Tests in this category include:
- Videonystagmography (VNG): A test battery in which many tests are used simultaneously. These tests examine eye movements and identify abnormal movements such as nystagmus.
- Caloric test: This is part of the VNG battery. It is based on heating and cooling the inner ear with air or fluid. It is a differential diagnostic test.
- v-HIT: The compensatory movement of the eyes in response to rapid head movements is examined.
- Vestibular Evoked Myogenic Potentials VEMP: These are tests in which the vestibular nerves are examined using sound stimuli.
- Hearing Examinations: These are tests that should be performed on every patient presenting with dizziness and imbalance, whether or not they have hearing-related complaints. They have differential diagnostic value.
How Can You Prevent Vertigo Attacks?
First, you must receive the correct diagnosis. Therefore, a detailed evaluation is absolutely necessary. The treatments and procedures to be applied can only be determined and planned after this.
Repositioning Procedures (MANEUVERS): This method aims to move the calcium particles located in the semicircular canals of the inner ear, which cause balance problems, back to their proper positions. These procedures generally relieve vertigo symptoms within a few sessions. They are not suitable for every type of dizziness.
Vestibular Rehabilitation Therapy: This form of treatment is suitable for all vestibular pathologies. It is most commonly recommended for conditions such as vestibular neuritis, labyrinthitis, unilateral or bilateral vestibular insufficiency, vestibular migraine, Ménière’s disease, 3PD (PPPD), and motion sickness. The therapy aims to reduce dizziness by improving the adaptation between incorrect signals coming from the inner ear and the brain. Supported by various exercises, this therapy contributes to long-term recovery.
Balance and Fall Risk Assessments: These assessments, performed with the help of specialized tests, reveal potential triggers for dizziness and imbalance. They allow the person’s balance abilities to be analyzed quantitatively.
- Tests used include videonystagmography and posturography.
- The information obtained from these tests enables personalized treatment plans to be prepared.
Frequently Asked Questions
Sudden dizziness may be caused by vertigo, but not every episode of sudden dizziness is vertigo. If there is a spinning sensation, imbalance, nausea, and symptoms that worsen with head movements, a detailed audiological and medical evaluation is recommended.
BPPV, vestibular neuritis, Ménière’s disease, and vestibular migraine are among the common causes of sudden dizziness. Changes in blood pressure, fluid loss, and certain medications may also cause similar complaints.
The perception that the surroundings are spinning, loss of balance, nausea, vomiting, and worsening of the complaint with head movements may suggest vertigo. The symptoms must be evaluated by a specialist for a definitive diagnosis.
During the diagnostic process, a detailed patient history, positional tests, hearing assessment, v-HIT, VEMP, VNG, and imaging methods when necessary may be used. Tests are planned according to the patient’s findings.
An audiologist evaluates the functions of the vestibular system in detail and helps determine whether the dizziness originates from the inner ear. Appropriate rehabilitation and follow-up may be planned according to the findings.
During dizziness, sudden movements should be avoided, the person should sit or lie down safely, and the symptoms should be monitored. If the complaints recur or last for a long time, specialist evaluation should be obtained.
If dizziness is accompanied by speech impairment, weakness in an arm or leg, altered consciousness, severe headache, double vision, or sudden hearing loss, an emergency healthcare facility should be consulted without delay.
Vestibular rehabilitation may be applied to patients who are diagnosed with an inner ear-related balance disorder and whose symptoms continue. Personalized exercises prepared by an audiologist may help improve balance and make daily life easier.
Intense stress and anxiety may increase the sensation of dizziness in some people or make existing vestibular symptoms more noticeable. However, attributing it only to stress is not appropriate; the underlying cause must be investigated.
When the cause of sudden dizziness is identified correctly, many types of vertigo may improve significantly with appropriate treatment and vestibular rehabilitation. Early diagnosis is an important factor that increases treatment success and quality of life.
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
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