Very often patients report that they suffer from vertigo. These patients are particularly stressed and fearful, reporting instability, feeling faint, disappearing, spinning objects, confusion, panic attacks, hypertension, migraine, etc. But often these symptoms are not vertigo.

What is vertigo?

Vertigo is a false sensation of rotation of objects or a sensation of rotation of the patient himself around the objects.
Vertigo is divided into peripheral and central type. Peripheral vertigo occurs in diseases involving the ear, the labyrinth. It is frequent and characterized by intense symptoms, with vomiting, nausea, which can be aggravated by changing the position of the head, can be accompanied by hearing loss, tinnitus and instability, can last from a few minutes to several days.

Causes of appearance

The main causes are:

• positional vertigo
• Meniere’s disease
• labyrinthitis
• tumors
• ear surgeries
• traumatic brain injury

Vertigo of central etiology refers to conditions involving the central nervous system. As a symptom, it is usually milder, of longer duration that is not aggravated by changing the position of the head and is mainly accompanied by neurological symptoms such as weakness, body drop, instability, diplopia, numbness, etc.

Main causes are migraine, multiple sclerosis, hypertension, metabolic diseases, craniocerebral injuries, cerebrovascular (blood clots) aneurysms, inflammations (eg encephalitis, tumors, drugs, etc.)

How is vertigo diagnosed?

In the differential diagnosis of vertigo, we conclude by exclusion (using algorithms):

• We take the patient’s history very carefully
• Complete audiological examination and labyrinth examination: otoscopy, audiogram, tympanogram, auditory reflex. We check if there is a ruptured eardrum, acute or chronic otitis, swelling in the external auditory canal, if he has a rash in the external auditory canal, if he has hearing loss (unilateral, bilateral) in high or low frequencies, sensorineural or conductive.
• With the Frenzel glasses we can accurately examine some eye movements called nystagmus that show us if the labyrinth is affected and who (Dixhalpike).
• Posture tests are performed (Romberg), the gait of Underberger, Fukuda, etc. is examined.

Depending on the findings, we are led to a diagnosis of peripheral vertigo or not. Imaging (Magnetic tomography of the brain and lithoids with contrast – carotid, vertebral triplex) and biochemical testing are often necessary.

If the vertigo is of central etiology, we refer the patient to the appropriate specialist (neurologist, neurosurgeon).


The treatment is proportional to our diagnosis.

If, for example, it is positional vertigo, “manipulations” called Epley, Semont et al. which are carried out in our on-site clinic. Most of the time, only these manipulations are enough to help the patient (1 session or 2) and Brandt – Daroff exercises. Cawthorne and Cooksey.

If peripheral vertigo is of another cause, we also give medication (circulation improvers, corticosteroids or some rehabilitation exercises such as Cawthorne and Cooksey).

Usually, we reassess the patient after days.

It is written by
Eleni Andreopoulou
Curator of Otorhinolaryngology Clinic HYGEIA