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

Feeling like the room is spinning when you roll over in bed? Or feeling off-balance walking down a grocery aisle? You’re not alone. About one in three people over 65 deal with some kind of balance problem, and vertigo is the most common reason they see a doctor. But here’s the catch: most people think it’s just dizziness. It’s not. Vertigo is a specific kind of spinning sensation-like you’re on a merry-go-round you didn’t get on. And it’s usually coming from your inner ear.

What’s Really Going On in Your Inner 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. Tiny crystals, called otoconia, sit in a nearby sac. These crystals help your brain sense head position and movement. When they get loose and drift into the wrong canal-usually the one pointing down your neck-you get vertigo. That’s benign paroxysmal positional vertigo, or BPPV. It’s the #1 cause of vertigo, responsible for up to 30% of all dizziness cases and half of all cases in older adults.

Why You Feel Like You’re Spinning

When you move your head-say, turning to look over your shoulder-the loose crystals shift with the fluid in the canal. Your brain gets confused. It thinks you’re spinning, even though you’re not. That’s why BPPV hits with quick head movements: rolling over, sitting up, looking up at a shelf. Each episode lasts seconds to a minute, but the fear of it coming back can make you avoid those movements entirely. And that’s where the real problem starts: you start moving less, your balance weakens, and you’re more likely to fall.

Other Inner Ear Culprits

BPPV isn’t the only player. Vestibular neuritis happens when a virus inflames the nerve that connects your inner ear to your brain. You get sudden, intense spinning that lasts days, sometimes weeks, but no hearing loss. Then there’s Meniere’s disease. It’s rarer but more complex. You get vertigo that lasts 20 minutes to half a day, plus ringing in the ear, muffled hearing, and that weird feeling of pressure. It’s caused by too much fluid building up in the inner ear. And while it sounds like a one-off problem, it often comes back-sometimes daily, sometimes months apart.

Is It Your Brain? (The 20% You Can’t Ignore)

About 20% of vertigo cases come from the brain-not the ear. This is where things get serious. If your vertigo comes with double vision, slurred speech, numbness, or trouble walking straight, it could be a stroke. That’s why doctors now use the HINTS exam: a quick test that checks eye movements and head control. Done within 48 hours of symptoms, it’s 97% accurate at spotting stroke-related vertigo. Most people don’t know this. They assume dizziness is always harmless. It’s not. If vertigo hits suddenly and doesn’t improve in a day or two, get checked. Don’t wait.

Medication Isn’t the Answer (Most of the Time)

You’ve probably heard of meclizine (Antivert) or promethazine. These drugs calm the spinning feeling. They work-for a few hours. But here’s the truth: they don’t fix the problem. They just mask it. And if you take them for more than 72 hours, your brain stops learning how to compensate. That means recovery takes longer. The Children’s Hospital of Philadelphia found that long-term use delays natural healing by 30-50%. So yes, a pill might help you get through the first night. But it won’t stop the next attack.

Vestibular Therapy: The Real Fix

This is where things change. Vestibular rehabilitation therapy (VRT) isn’t a magic trick. It’s physical therapy for your balance system. Think of it like rehab after a knee injury-but for your inner ear and brain. The goal? Train your brain to rely on other senses-your eyes and your body’s sense of position-to make up for the faulty signal from your ear.

How It Works

For BPPV, the Epley maneuver is the gold standard. It’s a series of head positions that gently guide the loose crystals back into the right spot. Done right, it works in 80-90% of cases after one or two tries. You can do it at home with a video guide, but most people need a therapist to make sure they’re doing it correctly. The first time? It might make you dizzy. The second? Less so. The third? Usually gone.

For Other Causes

If it’s vestibular neuritis or Meniere’s, VRT uses different exercises. Gaze stabilization helps you keep your eyes locked on a target while moving your head. Balance retraining teaches you to stand and walk safely on uneven surfaces. Habituation exercises slowly expose you to movements that trigger vertigo-so your brain learns they’re not dangerous. People who stick with it for 4-6 weeks see 70-80% improvement. But here’s the kicker: 30% quit early because the exercises make them dizzy at first. The good news? 95% of those who stick with it for two weeks feel dramatically better.

What About Diet and Lifestyle?

If you have Meniere’s, sodium is your enemy. Too much salt = more fluid buildup = more vertigo. Doctors recommend 1,500 to 2,000 mg a day. That’s tough. A single bag of chips has 300 mg. A slice of pizza? 800 mg. You need to cook at home, skip processed foods, and read labels like your life depends on it. And it kind of does. Studies show people who stick to this diet cut their vertigo attacks by half.

What About Migraines?

Vestibular migraine is the second most common cause of vertigo after BPPV. You don’t even need a headache. Just dizziness, light sensitivity, and nausea. Treatment? Migraine preventatives-meds like propranolol or topiramate. Not painkillers. Not anti-dizziness pills. The right meds can cut vertigo frequency by half. Keeping a daily diary of triggers-stress, sleep, food, weather-helps doctors find patterns. Most people find their triggers within four weeks.

Real People, Real Results

One patient on Healthgrades said: “After three months of being told it was anxiety, the Epley maneuver fixed me in 15 minutes. I wish my doctor had known to test for this.” Another said: “Meclizine made me too sleepy to work. The exercises took three weeks, but now I’m back to hiking.”

What’s New in 2026?

Smartphones are now part of the diagnosis. Apps like VEDA and VertiGo use your phone’s camera to detect tiny eye movements that signal BPPV. They’re 85% accurate. Telehealth lets you do the Epley maneuver with a therapist on video-even if you live in a rural town. And new drugs like eptinezumab (Vyepti) are now approved specifically for vestibular migraine. Research is even looking at gene therapy for Meniere’s. But the most powerful tool? Still vestibular rehab. It’s been working for 30 years. And it still works.

What to Do Next

If you’re dizzy or spinning:

1. Don’t panic. Most causes are treatable.
2. See a doctor within 48 hours if it’s sudden and severe-rule out stroke.
3. Ask: “Could this be BPPV?” Request the Dix-Hallpike test.
4. If you have hearing loss, ringing, or pressure, ask about Meniere’s.
5. Stop taking anti-dizziness meds after 72 hours unless your doctor says otherwise.
6. Ask for a referral to vestibular therapy. Don’t wait.

You don’t need to live with vertigo. Your brain can relearn balance. Your inner ear can heal. But you have to move-literally. The exercises are simple. The results? Life-changing.