Peripheral and neurologic vertigo (ear)- Dubai ENT Clinic 


Vertigo can be either peripheral or related to neurological issue. we will try to explain the differences, and how to manage vertigo.


Peripheral vertigo:

  • Severe vertigo mostly accompanied by nausea, vomiting, and sweating.
  • Sometimes with hearing loss and tinnitus.
  • Increases when eyes are closed.
  • No other symptoms between attacks.

 Neurologic vertigo:

  • Mild, continuous, not fatigable dizziness with weakness.
  • Numbness on fall attacks.
  • Feels better when eyes are closed.

 The most frequent cause of peripheral vertigo is benign paroxysmal positional vertigo (BPPV).


  • Repositioning of the canalith using clinical manoeuvres: Epley, and Semont maneuvers.
  • Use of vibration in the repositioning procedure.
  • Premedication for nausea and vomiting is recommended.
  • Postural restriction following canalith repositioning.
    • Head should be positioned at 30 degrees for two nights.
    • Don’t place the head on dependent position or sleep on the affected ear for one week.
  • Success rate is 90%. Repetition of manoeuvre is needed.
  • Recurrence rate is 30% to 50%. Repetition of manoeuvre is needed.
  • 90% posterior, 10% to 13% horizontal, 2% anterior.

 Contraindications for canalith repositioning manoeuvres:

  1. Acute fractures that prevent from lying down quickly or rolling over.
  2. Recent neck fracture, surgery, or instability.
  3. History of vertebral discectomy.
  4. Unstable carotid disease.
  5. Recent retinal detachment.


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