”Vertigo is a common clinical symptom that makes the patient feel spinning and uncomfortable. However, it is the disease or symptom that makes “patients dizzy and doctors dizzy”. In addition to being physically dizzy, another thing that makes patients feel dizzy is that they don’t know which department to go to. They don’t know what vertigo is and what dizziness is. And doctors are dizzy because they only know those few simple diseases that cause vertigo, such as cervical spondylosis and Ménière’s disease. This leads to a large number of vertigo disorders being misdiagnosed. Naturally, the treatment is also less effective, leading to patients’ fear of vertigo. So how do we keep vertigo from making patients dizzy and from making doctors dizzy themselves? First, we need to distinguish what vertigo is and what dizziness is. Vertigo is the body’s misperception of where it is in space. In layman’s terms, it is the perception of a non-moving object as a moving object. Patients may feel that objects around them are rotating or that the patient is rotating, such as a sense of swaying, floating, or lifting. This is generally translated as “vertigo”. Dizziness, on the other hand, is a broader concept and is translated as “dizziness” in English. Sometimes it includes symptoms such as vertigo and dizziness, and sometimes it refers specifically to dizziness to distinguish it from vertigo. The presence or absence of motion hallucinations is generally considered to be the fundamental difference between vertigo and dizziness. If the patient has visual rotation, then we call him vertigo, and if he doesn’t have this symptom, we consider it dizziness. Of course sometimes it is difficult to separate vertigo from dizziness, for example, some diseases start with a violent vertigo, and after a violent attack, it manifests itself as a dizziness, a feeling of lightheadedness during the recovery period. After separating vertigo and dizziness, let’s look at the diseases that tend to cause vertigo and those that cause dizziness. Generally speaking, vertigo is mainly caused by the vestibular system, which is an integrated nervous system that maintains body balance and sensory movement. It mainly consists of the vestibular vestibule for input signals, the vestibular center for signal processing, which includes some structures of the brainstem and cerebellum, and the organs for output signal control: such as the eye and muscles. The vertigo caused by the vestibular vestibule is generally called peripheral vertigo and is mostly caused by the dysfunction of the vestibular semicircular canal. Most of the vertigo is more intense, but the patient does not have obvious symptoms of the central nervous system such as impaired consciousness and headache. In contrast, vertigo caused by the vestibular center is usually accompanied by more severe central system symptoms, such as impaired limb movement, facial palsy and other manifestations, and can be accompanied by headache and other symptoms. At the same time, peripheral vertigo usually has short episodes, rarely lasting more than one or two days, while central vertigo has longer episodes. Therefore, it is possible to consult a doctor according to different conditions. Peripheral vertigo is usually seen in otorhinolaryngology, while central vertigo is seen in neurology. What are the diseases that can cause vertigo? Most people would think that cervical spondylosis and Meniere’s disease are common. In fact, cervical spondylosis can cause vertigo very rarely, and some people even think that cervical spondylosis cannot cause vertigo at all, and it is indeed rare to see vertigo caused by cervical spondylosis in clinical practice. Meniere’s disease, on the other hand, does cause recurrent vertigo, which accounts for about 10% of all vertigo. In fact, the most common cause of vertigo is benign positional vertigo (BPPV), commonly known as otoliths, which is thought to account for 30% of all vertigo, which is a bit exaggerated, but reflects the large proportion of benign positional vertigo in patients with vertigo. The treatment of benign positional vertigo is immediate, and usually good results can be obtained by resetting. Some infectious diseases in the ear can also cause vertigo, such as vestibular neuronitis, cholesteatoma otitis media, and multiple sclerosis. In addition, anatomical abnormalities such as superior semicircular canal cleft syndrome and exolymphatic leak can also cause vertigo, and these diseases account for about 10% of vertigo. Vestibular paroxysms, which are caused by tortuous malformations of the vessels in the internal auditory tract compressing the vestibular nerve, can also cause vertigo. There is also migrainous vertigo, which some people believe is not low in incidence, but just a lot of it is misdiagnosed. Most of the above diseases are peripheral vertigo. Central vertigo is mainly seen in lesions such as tumors, hemorrhage, and infarction of the cerebellum and brainstem, which account for more than 10% of vertigo. At the same time there are some vertigo, the cause of which is still difficult to find with the present means, but this is a relatively rare case. It should also be suggested that although we know that so many diseases can cause vertigo, the diagnosis of vertigo is not so simple that it can be diagnosed just by looking at it, which requires some relevant tests to clarify the cause of vertigo. If you know what causes vertigo, then you can treat it. The treatment of vertigo is divided into symptomatic treatment and disease-specific treatment. Symptomatic treatment is mainly to apply drugs to suppress vestibular reactions, such as Minerva, multiplying dizziness, etc. You can also apply vestibular exercise and vestibular habit therapy to treat the symptoms. The targeted treatment is based on the different diseases to be treated. As we described earlier, benign positional vertigo can be treated by otolithic repositioning, and different repositioning methods can be selected according to different hallux valgus, and most of them can get good results. Superior hallux cleft syndrome can be treated surgically by repairing the broken hallux, cholesteatoma-type otitis media also requires surgery, while vestibular paroxysms can be treated with drugs such as carbamazepine. In conclusion, vertigo as a symptom is not so mysterious, but it is possible to obtain good results. If we pay attention to diagnosis and treatment, we can make every vertigo patient no longer dizzy.