Vertigo (ENT Evaluation)

Vertigo is the false perception of motion, typically described as spinning, tilting or swaying, distinct from non-specific dizziness, presyncope or disequilibrium. It results from dysfunction in the vestibular system, which integrates inputs from the inner ear labyrinth, vestibular nuclei, cerebellum and cerebral cortex.

Peripheral vertigo (most common) arises from inner ear pathology: benign paroxysmal positional vertigo (BPPV) due to displaced otoliths, Ménière's disease (endolymphatic hydrops with vertigo, hearing loss, tinnitus), vestibular neuritis (presumed viral inflammation of vestibular nerve), labyrinthitis, perilymph fistula, superior canal dehiscence and ototoxic drug effects.

Central vertigo originates from brainstem or cerebellum and includes vestibular migraine, posterior circulation stroke, cerebellopontine angle tumor (vestibular schwannoma) and multiple sclerosis. The HINTS examination (Head Impulse, Nystagmus, Test of Skew) helps differentiate peripheral from central etiology in acute vestibular syndrome and is more sensitive than early MRI for stroke.