Diagnosing Vertigo

NYU Langone doctors diagnose vertigo, which is a feeling of spinning, tilting, or disorientation, even when you are still. This sensation can be so strong that it prevents you from walking straight. Some people vomit or feel nauseated.

Vertigo occurs when the body’s perception of its position in space is disrupted. It may come and go, or it may last for weeks or months. Often, vertigo goes away on its own, but there’s no way to predict when that may be. In some instances, vertigo is resistant to treatment.

Vertigo can have a significant impact on your daily life. Feeling unstable and dizzy can make basic tasks, such as crossing the street or driving a car, a challenge. It also increases your risk of falling.

Our doctors recommend that you go to the nearest emergency room if vertigo prevents you from standing up for more than a few minutes.

Types and Causes 

Doctors may diagnose vertigo as being peripheral or central. Peripheral vertigo is caused by a problem in the inner ear. Central vertigo is caused by a medical condition affecting the area of the brain that controls balance and spatial awareness. 

While a cause of vertigo can sometimes be identified, doctors cannot always determine exactly why it occurs. 

Peripheral Vertigo

Peripheral vertigo originates in the vestibular system, a group of tiny organs and canals—including the innermost part of the ear—that control balance. In addition to dizziness, a person with peripheral vertigo may also experience hearing loss or tinnitus, which is a ringing in the ears.

The most common type of peripheral vertigo is benign paroxysmal positional vertigo. This type of vertigo occurs when tiny crystals in the inner ear, which sense movement and help maintain balance, shift out of position or clump together. The inner ear then signals to your brain that you are moving, even when you are standing still.

Specific head movements often trigger this type of vertigo. For example, turning your head to one side may cause a sensation of spinning and nausea. 

Other conditions that affect the inner ear and may cause vertigo include Ménière’s disease, a disorder that disrupts balance, and labyrinthitis, a swelling in the nerve that travels from the inner ear to the brain. Acoustic neuroma, a noncancerous growth in the nerve pathway between the inner ear and the brain, may also be responsible for vertigo. 

Certain medications may damage the inner ear and lead to vertigo. These include some chemotherapy drugs, certain antibiotics, and loop diuretics, which are prescribed to treat kidney and heart disease. Aspirin may also cause vertigo when taken in large doses.

Central Vertigo

Central vertigo is much less common than the peripheral type. It can result from an illness or injury affecting the brain, such as a concussion, stroke, or migraine. All of these conditions can affect the brain stem or the cerebellum—the regions of the brain that control balance. 

NYU Langone otolaryngologists—also known as ear, nose, and throat doctors—work with audiologists, who are specialists in disorders of the ear, to diagnose vertigo and, if possible, to determine the underlying cause. 

Medical History

To diagnose vertigo, your doctor relies on information about your medical history, including details about your symptoms. He or she may ask what the sensation of movement or dizziness feels like, how often it occurs, whether it occurs more frequently when you move a particular way or at certain times of the day, and whether you also experience hearing loss or ringing in the ears.

Your doctor may also ask if anyone else in your family has been diagnosed with a condition affecting balance or hearing. He or she also wants to know if you have had an infection, injury, or surgery in the ear or brain. 

Your doctor asks about how vertigo affects your everyday life, and whether it interferes with your daily routine. Some people develop anxiety as a result of vertigo, causing them to remain indoors or worry about the cause of symptoms. Talking to your doctor about these issues may help him or her to determine the best treatment. 

Physical Exam

An otolaryngologist performs a physical exam to look for signs and symptoms of the cause of vertigo. He or she uses delicate instruments to magnify and examine the ear canal and eardrum.

Your doctor may also examine your eye movements or ask you to track an object from one point in space to another. If you have trouble with this task, or if you experience rapid eye movements or blurred vision, your doctor may refer you to an eye doctor for further testing.

Hearing Tests

An audiologist conducts a variety of hearing tests, also called audiometric tests, to gather information about the ear. Hearing tests also help doctors assess whether there is a problem with the nerve that connects the inner ear to the brain, and whether dysfunction affects both ears. 

A hearing test at NYU Langone takes place in an onsite testing suite, where you sit in a sound-treated booth wearing headphones. For about 30 to 60 minutes, an audiologist evaluates different parts of your hearing using various techniques. 

In otoacoustic emissions testing, a sensitive probe that produces a combination of sounds is introduced into the ear canal. If the inner ear is functioning properly, small hair cells in the ear—tiny sensory receptors that detect vibrations and convert them to electrical signals for the brain to interpret—send back an echo when stimulated by sound. The probe can detect this echo, indicating how well the inner ear is functioning.

Videonystagmography Testing

Videonystagmography is used to evaluate the function of the inner ear using a series of visual and sensory tests. The inner ear constantly sends signals to your eye muscles to help the head and body maintain balance. This type of testing allows audiologists to record and interpret eye movements and confirm whether inner ear dysfunction is responsible for vertigo.  

At NYU Langone, videonystagmography testing takes place in a testing suite within your audiologist’s office. During the first part of testing, you wear a pair of goggles specially designed to illuminate your eyes using infrared light, which your eyes can’t detect. A video camera with an infrared lens is built into the goggles and records your eye movements during the test.

By using infrared light, videonystagmography avoids the possible distraction of visible light. This allows you to focus on the visual stimuli in the test. 

While wearing the goggles, you are seated in front of a large television screen. Your audiologist guides you through the testing. A variety of shapes, objects, and spots of light appear on the screen, and you are asked to perform certain tasks with your eyes while keeping your head still. These may include following a colored light as it moves across the screen in different directions or tracking an object as it jumps around the screen. 

Your audiologist also uses caloric, or temperature, testing to stimulate the inner ear with gentle bursts of warm or cold air. He or she is trying to determine how dizzy this makes you feel. The infrared goggles record your eye movements while caloric testing takes place.

Afterward, your audiologist analyzes the eye movement data obtained by the goggles and looks for patterns indicating an inner ear disorder as the cause of vertigo.

Rotational Chair Testing

Audiologists use rotational chair testing to obtain more information about whether vertigo is of peripheral or central origin. In a lab at NYU Langone, you are seated in a mechanized chair that slowly rotates. You wear special goggles that record your eye movements while you are in the chair.

Audiologists analyze your eye movements and interpret how they relate to the health of the inner ear. 

Additional Tests

Additional tests of the inner ear may be suggested for certain conditions. In vestibular evoked myogenic potentials testing, audiologists measure a natural response of the vestibular system and neck muscles to certain sounds. Electrocochleography helps determine if fluid buildup causes excess pressure in the inner ear, which can lead to vertigo symptoms.

An audiologist may also utilize these tests to measure the response of the inner ear to sound stimuli. 

MRI Scans

In some people with vertigo—in particular those who also have hearing loss—doctors may recommend an MRI scan to obtain a closer look at the inner ear and surrounding structures. MRI scans use a magnetic field and radio waves to create computerized, three-dimensional images of the ear and the nerve that carries signals from the inner ear to the brain. 

An MRI scan may reveal a buildup of fluid or inflammation in the inner ear or a growth on the nerve.

Neurological Testing

If hearing or sensory tests indicate vertigo of central origin, doctors may refer you to a specialist for neurological testing and treatment.