Vertigo is a common clinical condition, not an independent disease in itself, but often a manifestation of a disease in a clinically related discipline. Although vertigo is a common symptom, patients often go to neurology, orthopedics, otorhinolaryngology or psychiatry because they do not know how to deal with this condition due to the lack of awareness of the majority of patients, including clinicians. So, how should you consult a doctor once you have vertigo symptoms? It is necessary to talk about the following aspects. First of all, we should understand why people have vertigo, which starts from the function of our body organs. We cannot maintain the balance of our body without the “balance triad” consisting of the vestibular system of the inner ear, vision and proprioception. The vestibular system plays an important role as the main organ that maintains balance and perceives the relationship between the body and its surroundings. The two saccades (otolithic apparatus) and the three semicircular canals of the potbelly crest, located in the vestibule of the inner ear, sense linear and angular acceleration stimuli, respectively. The visual and proprioceptive systems are also part of the balance triad and have the role of transmitting balance information. The vertigo caused by these two systems is mild, short-lived and often masked by visual and proprioceptive disturbances. The vestibular system is interconnected with the visual system and the proprioceptive system to maintain our clear vision and postural balance, and damage to one of the three localized senses can send abnormal impulses that cause vertigo. The importance of the vestibular system in the body’s balance cannot be overstated, and once damage to the vestibular system occurs, it can lead to low vestibular system function and symptoms of vertigo. For example, otoliths, Ménière’s disease, vestibular neuritis, etc., all of which are caused by changes in the structure and function of the inner ear for various reasons. Other diseases include “delayed membranous vagal effusion”, “sudden deafness with vertigo”, and “vaginitis”, all of which are closely related to otolaryngology. According to incomplete statistics, vertigo caused by the above-mentioned otolaryngological diseases accounts for about 70% of all vertigo; in addition, some neurological diseases such as “posterior circulation ischemia”, “multiple sclerosis”, “intracranial occupancy”, etc. can also cause vertigo. In addition, some neurological diseases such as “posterior circulation ischemia”, “multiple sclerosis” and “intracranial occupancy” can also cause vertigo symptoms, accounting for about 11% of vertigo; vertigo caused by cervical spine diseases is not common; in addition, about 14% of vertigo is undiagnosed and needs treatment and observation. This shows that vertigo is a very complex symptom, closely related to several disciplines, so misdiagnosis occurs in clinical practice. The most important concern is what to do in case of vertigo and where to seek medical attention first. This depends on the situation, but for older patients we recommend to go to neurology first to rule out central vertigo to avoid serious consequences. In addition, since most vertigo is caused by otorhinolaryngological diseases, it is also possible to consult the otorhinolaryngology department first. It is also possible to broadly infer the classification of vertigo based on the characteristics of vertigo, the triggers of its onset and the accompanying symptoms. For example, if you have recurrent episodes of vertigo, with rotating vision and position-related symptoms, and if you are afraid to lie down or get up, or if you are afraid to turn around after lying down, and if you have episodes of vertigo for a few tens of seconds each time, accompanied by nausea and vomiting, we can roughly deduce the possibility of having “otoliths” from this information. If you have recurrent episodes of vertigo that last from 20 minutes to several hours, accompanied by tinnitus, dullness and fluctuating hearing loss on one side of the ear.
The possibility of Meniere’s disease is basically assumed. “Otolithiasis and Ménière’s disease are the two most common types of vertigo, accounting for about 50% of all vertigo, and they are both classified as otolaryngology. In addition, patients with “sudden deafness with vertigo” often have sudden onset of unexplained tinnitus on one side, severe hearing loss and subsequent vertigo symptoms, and some have vertigo as the first symptom. It differs from “Meniere’s disease” in that it rarely recurs, but the degree of hearing loss is more pronounced than in Meniere’s disease, which is characterized by recurrent attacks of vertigo and repeated fluctuating hearing loss. In the case of “delayed membranous effusion”, there is a severe deafness (almost total deafness) on one side first, and the vertigo symptoms start to appear after several years, decades or decades. This shows that vertigo is quite closely related to otolaryngology. It should be emphasized that certain neurological diseases can also present with obvious vertigo symptoms, but they are often accompanied by neurological symptoms such as diplopia, visual field loss, oculomotor disorders, transient consciousness disorders, unsteadiness in walking, sensory abnormalities, ataxia, etc. The consequences of these diseases are serious and need to be taken seriously enough. The above is only an inference from the patient’s medical history and symptoms to give a general classification of vertigo in order to clarify the direction of diagnosis, but the real diagnosis needs to be supported by some necessary auxiliary tests. To sum up
The causes of vertigo are complex, so in order to get a satisfactory diagnosis as soon as possible, you should prefer to visit a vertigo specialist clinic or vertigo treatment center, or if there is no such institution, you can first consult otorhinolaryngology or neurology, because the causes of vertigo are mainly concentrated in these two disciplines. When choosing otolaryngology for consultation, you should choose a doctor who specializes in otologic diseases so that vertigo can be properly diagnosed and treated.