Vertigo and Dizziness: Understanding Inner Ear Disorders and How Vestibular Therapy Helps

Feeling like the room is spinning when you haven’t moved? Or feeling lightheaded, off-balance, or nauseous for no clear reason? You’re not alone. About one in three people over 65 experience some kind of balance problem, and vertigo is the most common reason they seek help. But vertigo isn’t just dizziness-it’s a specific sensation of movement when you’re still. And it’s often rooted in your inner ear, not your brain or your anxiety.

What’s Really Going On Inside Your Ear?

Your inner ear isn’t just for hearing. It’s your body’s built-in gyroscope. Inside each ear, there are three fluid-filled loops called semicircular canals, and tiny calcium crystals called otoconia that sit in a chamber nearby. These crystals help your brain sense head position and movement. When they’re in the right place, you stay balanced. When they get loose-often from aging, head bumps, or just unknown causes-they drift into the wrong canal. That’s BPPV, or benign paroxysmal positional vertigo. It’s the #1 cause of vertigo, making up 20-30% of all dizziness cases, and over half of cases in people over 65.

When you roll over in bed, look up, or bend down, those loose crystals jiggle the fluid in the canal. Your brain gets mixed signals: “You’re spinning!” even though you’re not. The episode lasts seconds to a minute, but it’s terrifying. You might feel sick, sweat, or even vomit. And because it happens with movement, many people avoid turning their head altogether-which makes things worse.

Other inner ear problems include vestibular neuritis, where a virus inflames the nerve that connects your inner ear to your brain. That causes intense, continuous spinning for days, sometimes weeks, but no hearing loss. Then there’s Meniere’s disease-a rare but debilitating condition where fluid builds up in the inner ear. It brings vertigo that lasts hours, ringing in the ear, muffled hearing, and that weird feeling of fullness. It’s not just dizziness; it’s a full sensory storm.

Is It Your Brain or Your Ear?

Not all vertigo comes from the ear. About 20% of cases are central-meaning they start in the brainstem or cerebellum. These are rarer, but more serious. A stroke, multiple sclerosis, or a tumor can cause vertigo, too. The key difference? Central vertigo often comes with other red flags: double vision, slurred speech, weakness on one side, or trouble walking straight. If you have those, you need emergency care right away.

But the most common brain-related cause? Vestibular migraine. You don’t even need a headache. Just dizziness lasting minutes to days, sensitivity to light or sound, and maybe nausea. It’s often missed because doctors think, “No headache, so it’s not migraine.” But 1-3% of people have this, and it’s the second most common cause of vertigo after BPPV.

Here’s the catch: most primary care doctors don’t test for BPPV. A 2022 study found half of BPPV cases are misdiagnosed as anxiety or general dizziness. That’s why you might see three doctors over three months before getting the right answer. The fix? A simple test called the Dix-Hallpike maneuver. Your doctor sits you up, then quickly lowers you back with your head turned and hanging off the table. If you get spinning and your eyes jerk in a specific way, it’s BPPV. It takes 30 seconds. No machines. No blood tests. Just a trained hand.

The Epley Maneuver: A 15-Minute Fix

If you have BPPV, there’s good news: it’s usually curable in one or two visits. The Epley maneuver is a series of slow head movements designed to guide those loose crystals back into their proper chamber. Done right, it works in 80-90% of cases. Many people feel better within minutes.

You can do it at home after your doctor shows you how. But doing it wrong won’t help-and might make it worse. You need to hold each position for at least 30 seconds, keep your head at a 30-degree angle, and avoid looking up or lying flat for 48 hours after. A video guide helps. Some clinics even send patients home with a QR code linking to a demo.

But here’s what most people don’t know: if you’re not doing the maneuver correctly, you’re just wasting time. A 2023 Mayo Clinic study showed that 70-80% of home attempts fail because people skip steps or rush through them. That’s why it’s best to get it done in the office first, then follow up with home practice.

Vestibular Therapy: Training Your Brain to Rebalance

Not every vertigo problem can be fixed with a head tilt. For vestibular neuritis, Meniere’s, or vestibular migraine, your body needs time to relearn balance. That’s where vestibular rehabilitation therapy (VRT) comes in.

Vestibular therapy isn’t just exercises. It’s a personalized program designed to retrain your brain to rely on other senses-your eyes, your legs, your body’s sense of position-when your inner ear is sending bad signals. It includes:

• Gaze stabilization: Keeping your eyes locked on a target while moving your head side to side or up and down.
• Balance retraining: Standing on one foot, walking heel-to-toe, or standing on foam to challenge your stability.
• Habituation: Repeated exposure to movements that trigger dizziness, so your brain learns they’re not dangerous.

Studies show 70-80% of people improve significantly within 4-6 weeks. But here’s the catch: the first week feels awful. You’ll feel more dizzy, maybe even nauseous. That’s normal. Your brain is rewiring. Most people quit before the second week because they think it’s not working. But 95% of those who stick with it for two weeks see real improvement.

One patient in Leeds told me: “I did the exercises every morning and night. Week one, I cried. Week two, I could walk to the bus stop without holding the wall. Week three, I went hiking.” That’s not magic. That’s neuroplasticity-your brain’s ability to adapt.

Medications: Temporary Help, Long-Term Risk

Doctors often reach for meclizine (Antivert) or promethazine when vertigo hits. They help with nausea and dizziness. But they don’t fix the cause. Worse-they slow down your brain’s natural recovery.

When you take these drugs, they suppress the signals from your inner ear. That’s good for a few hours. But if you keep taking them for days or weeks, your brain doesn’t learn to compensate. The Children’s Hospital of Philadelphia found that using vestibular suppressants longer than 72 hours can delay recovery by 30-50%. That means you could be stuck feeling off for months when you could have been back to normal in weeks.

For Meniere’s disease, doctors prescribe diuretics (water pills) and a strict low-sodium diet-under 2,000mg a day. That’s hard. Most processed foods have more sodium than that in one serving. But cutting salt reduces fluid buildup and cuts vertigo attacks by half for 60-80% of people.

For vestibular migraine, migraine preventatives like propranolol or topiramate work better than anything else. They don’t stop the dizziness immediately, but over time, they reduce frequency by 50% or more.

What to Do When You Feel Off

If you’re dizzy right now, here’s what to do:

1. Don’t panic. Sit or lie down. Close your eyes. Breathe slowly.
2. Don’t reach for meds yet. Wait 24 hours. Let your body reset.
3. Track your symptoms. When did it start? What were you doing? Did it happen after turning your head? Did you have a headache? Write it down.
4. See a specialist. Not your GP. Go to an ENT or vestibular therapist. Ask: “Could this be BPPV? Can you do the Dix-Hallpike test?”
5. If you have other symptoms-slurred speech, numbness, vision changes-go to the ER. It could be a stroke.

And if you’ve had vertigo before? Don’t wait until it’s bad again. Learn the Epley maneuver. Do your VRT exercises even when you’re fine. Prevention is easier than cure.

What’s New in 2026

The field is changing fast. Smartphone apps like VEDA and VertiGo can now detect eye jerks that signal BPPV with 85% accuracy. You can record your own eye movements with your phone’s camera and send them to a specialist. No clinic visit needed.

There’s also a new FDA-approved drug for vestibular migraine-eptinezumab (Vyepti)-that reduces vertigo attacks by half in 61% of users. And researchers are testing a pill that stops otoconia from breaking loose in the first place. Early trials show it cuts BPPV recurrence by 40%.

But the biggest breakthrough isn’t a drug or a device. It’s awareness. More doctors are learning to test for BPPV. More patients are asking for vestibular therapy. And more people are realizing: vertigo isn’t something you just live with. It’s something you can fix.

Next Steps

If you’re still dizzy after a week, don’t keep waiting. Make an appointment with an ENT or vestibular therapist. Bring your symptom diary. Ask for the Dix-Hallpike test. If it’s BPPV, get the Epley maneuver. If it’s something else, ask about vestibular rehab. Don’t let fear or confusion hold you back. Your balance isn’t gone forever. Your brain can relearn. And with the right help, you’ll feel steady again.