In South Africa, vertigo is managed by ents. Vertigo is a false sense of motion — most often spinning — that arises when the brain receives mismatched balance signals from the inner ear, eyes, and joints. It accounts for roughly 4-5% of all primary care visits and affects about 20-30% of adults at least once in their lifetime, with prevalence rising sharply after age 60.
Vertigo (ICD-10: H81 for peripheral vestibular disorders; R42 for dizziness and giddiness not otherwise specified) is the illusion of movement — typically rotational — generated when the peripheral vestibular apparatus, the central vestibular pathways, or their integration with vision and proprioception is disrupted. It is a symptom, not a disease: the clinical task is identifying which of more than thirty named disorders is producing it. The peripheral vestibular system comprises the three semicircular canals and the otolith organs (utricle, saccule) of the inner ear and the vestibular nerve (CN VIII). Peripheral causes — BPPV, vestibular neuritis, labyrinthitis, Meniere disease — account for roughly 80% of presentations.
The key symptoms of Vertigo are: A spinning sensation — either the room spinning around the person or the person feeling they are spinning — that is the defining feature of true vertigo and distinguishes it from light-headedness or unsteadiness., Brief positional spinning lasting 10-60 seconds and triggered by rolling over in bed, looking up, or bending down — the classic BPPV pattern., Sudden, severe continuous spinning lasting hours to days with intense nausea and the inability to stand, typical of vestibular neuritis or acute labyrinthitis., Episodes of spinning lasting 20 minutes to 12 hours accompanied by fluctuating hearing loss, tinnitus, and a feeling of pressure or fullness in one ear — the Meniere triad., Nausea and vomiting that accompany most acute vertigo episodes, sometimes severe enough to cause dehydration during prolonged spells., Horizontal or rotary nystagmus visible on examination — involuntary eye movements that beat in a characteristic direction depending on the affected canal or nerve., Gait imbalance and a tendency to veer toward the affected side, with patients describing the floor as tilting or moving beneath them..
Diagnosis follows a sequence: timing and triggers from the history, bedside examination focused on nystagmus and balance, then targeted testing. The TiTrATE framework (Timing, Triggers, And Targeted Examination) classifies presentations into acute prolonged (single episode lasting days), episodic triggered (brief spells with positional or other triggers), and episodic spontaneous (recurrent without trigger). Each pattern points to a different short list of causes. For brief positional vertigo, the Dix-Hallpike maneuver remains the gold-standard test for posterior-canal BPPV and is the only step needed before treatment per the 2017 AAO-HNS BPPV clinical practice guideline (Bhattacharyya). For acute continuous vertigo lasting days, the HINTS exam — Head-Impulse, Nystagmus, and Test of Skew — distinguishes peripheral vestibular neuritis from posterior circulation stroke with sensitivity exceeding 96% (Kattah Stroke 2009), outperforming early MRI in the first 48 hours when up to 20% of small posterior strokes can be falsely negative on diffusion-weighted imaging. For recurrent spontaneous episodes, history is decisive: episodes lasting 20 minutes to 12 hours with hearing loss point to Meniere disease (Lopez-Escamez 2015 / AAO-HNS 2020); episodes lasting 5 minutes to 72 hours with migrainous features point to vestibular migraine (Lempert 2012 Barany). Audiometry, video-nystagmography (VNG), and vestibular evoked myogenic potentials (VEMP) refine the diagnosis. MRI with gadolinium is reserved for suspected central causes, unilateral sensorineural hearing loss, focal neurologic signs, or treatment-refractory cases — not as a routine first test.
Prognosis depends heavily on the underlying cause. BPPV is the most favorable: 80-90% of patients clear with one to three Epley maneuvers, though recurrence affects 30-50% within 5 years. Vestibular neuritis resolves over 4-6 weeks in most patients, with about 50% achieving full caloric recovery at one year and the remainder compensating centrally so that residual deficits are usually subtle. Meniere disease tends to burn out over 5-15 years, with vertigo episodes diminishing while permanent hearing loss progresses; only 5-10% of patients require surgical intervention. Vestibular migraine has a fluctuating course tied to migraine activity overall, with 50-75% experiencing meaningful reduction on adequate prophylaxis. Central vertigo from stroke has the worst prognosis of the common causes — outcome is determined by infarct size and location, with cerebellar strokes often leaving residual imbalance even with full neurological recovery. Persistent postural-perceptual dizziness, once chronic, responds well to combined vestibular rehabilitation, cognitive behavioral therapy, and SSRI or SNRI medication in roughly 70% of patients but rarely resolves spontaneously.
Refer to ENT or neurology when vertigo is recurrent or severe enough to limit daily function, when diagnosis is unclear after primary-care evaluation, when hearing loss accompanies vertigo, when neurologic signs are present, when BPPV fails to clear after two Epley maneuvers, when vestibular migraine fails one full prophylactic trial, or when Meniere disease progresses despite first-line measures. Same-day emergency department evaluation is required for vertigo with any of the HINTS-central pattern, focal neurologic signs, severe headache, or sudden hearing loss.
Find specialists →BPPV: vertigo eliminated within minutes to days of a successful Epley maneuver; mild positional unsteadiness can persist for 1-2 weeks during central recalibration. Vestibular neuritis: severe acute phase lasts 24-72 hours, daily improvement over 2-4 weeks, and stable residual function reached by 3-6 months. Meniere episodes: each individual attack lasts 20 minutes to 12 hours; between attacks, function returns to baseline early in the disease and incompletely later. Vestibular migraine: episodes resolve over 5 minutes to 72 hours; full prophylactic benefit takes 8-12 weeks. PPPD: gradual improvement over 3-12 months with combined vestibular rehabilitation, CBT, and pharmacotherapy.
Stay physically active between vertigo episodes — sustained inactivity slows central vestibular compensation and worsens chronic dizziness. Walking, swimming, and stationary cycling are all safe choices. Vestibular rehabilitation exercises prescribed by a trained therapist (gaze stabilization, habituation drills, balance training) are the cornerstone of recovery and should be performed daily as advised. Avoid head-down positions and rapid rotational sports during active BPPV until cleared by your clinician.
Look for an otolaryngologist or neurologist with subspecialty interest in vestibular disorders or a multidisciplinary balance clinic. Useful credentials include fellowship in neurotology or otology, comfort with Dix-Hallpike and Epley procedures, access to videonystagmography and audiology, and a working relationship with vestibular physical therapy. For suspected stroke, the relevant specialist is a stroke neurologist via emergency care, not an ENT.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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