From the Guidelines
For chronic vertigo, you should see an otolaryngologist (ENT specialist) or a neurologist with expertise in vestibular disorders. ENT specialists are often the first choice as they specialize in ear conditions that commonly cause vertigo, such as benign paroxysmal positional vertigo (BPPV), Meniere's disease, or vestibular neuritis 1. Neurologists are particularly helpful if your vertigo might be related to migraines, multiple sclerosis, or other neurological conditions. Some medical centers have dedicated vestibular specialists or balance disorder clinics with professionals specifically trained in diagnosing and treating complex vertigo cases. Your primary care physician can provide an initial evaluation and appropriate referral based on your specific symptoms and medical history.
Key Considerations
- The diagnosis of vertigo involves differentiating between peripheral causes (such as BPPV) and central causes (such as neurological disorders) 1.
- Treatment approaches vary widely depending on the underlying cause, ranging from vestibular rehabilitation exercises to medications like antihistamines, anticholinergics, or benzodiazepines for symptom management, to more specific treatments targeting the root cause of your vertigo 1.
- A thorough otologic history and physical examination are essential in evaluating patients with suspected vertigo, including questions about the nature of the onset, duration of active vertigo, and concurrent otologic symptoms 1.
- Clinicians should offer a limited course of vestibular suppressants to patients with Ménière’s disease for management of vertigo only during Ménière’s disease attacks 1.
Specialist Referral
- ENT specialists are the primary referral choice for ear conditions causing vertigo.
- Neurologists are recommended for vertigo related to neurological conditions.
- Vestibular specialists or balance disorder clinics may also be appropriate for complex cases.
From the Research
Specialist Referral for Chronic Vertigo
For chronic vertigo, the following specialists can be referred to:
- An Otolaryngologist (ENT specialist) for evaluation and treatment of inner ear disorders such as Benign Paroxysmal Positional Vertigo (BPPV) and Meniere's disease 2, 3, 4, 5
- A Neurologist for evaluation and treatment of central nervous system disorders that may be causing vertigo 3
- A Vestibular Rehabilitation Therapist for rehabilitation and treatment of balance and vestibular disorders 6
Diagnosis and Treatment
Diagnosis of chronic vertigo involves a thorough clinical evaluation, including:
- Taking a precise clinical history 2
- Performing the Dix-Hallpike manoeuvre to diagnose BPPV 2, 4, 5
- Complete audiological and otoneurological evaluation to rule out other inner ear pathologies 2 Treatment options for chronic vertigo include:
- Epley's canal repositioning manoeuvre for BPPV 2, 4, 5
- Vestibular rehabilitation therapy 6
- Medication or surgery for other underlying conditions causing vertigo 3