Comprehensive vestibular assessment and 3D virtual reality rehabilitation – Clínica SENT, Granada (Spain)

If you are reading this page, you may be experiencing vertigo, dizziness, or a persistent sense of imbalance. These symptoms can be unsettling, especially when they appear suddenly or interfere with daily activities such as walking, working, or even turning in bed. Our aim is to provide a clear, medically grounded explanation of what vertigo is, why it happens, how it is properly diagnosed, and what effective treatment really looks like.

If your symptoms are sudden, intense, or associated with neurological warning signs such as double vision, difficulty speaking, weakness, numbness, or a severe headache, urgent medical assessment is essential.

---

What is vertigo?

Vertigo is a false sensation of movement. Patients often describe it as spinning, tilting, swaying, or being pulled to one side. Unlike simple lightheadedness or fainting, vertigo specifically reflects dysfunction of the vestibular system—the inner ear balance organs and their connections to the brainstem and cerebellum.

It is important to understand that vertigo is not a disease in itself. It is a symptom that can arise from several different conditions. In some cases, it lasts only seconds; in others, it may persist for days or recur in episodes over months or years. The clinical context and associated symptoms are crucial to identifying the underlying cause.

---

Which conditions can cause vertigo?

One of the most common causes is Benign Paroxysmal Positional Vertigo (BPPV). This condition produces brief but intense spinning sensations triggered by specific head movements, such as lying down, turning in bed, or looking upward. It occurs when tiny calcium crystals (otoconia) become displaced within the semicircular canals. Although the sensation can be dramatic, BPPV is benign and highly treatable with repositioning maneuvers performed in the clinic.

Another frequent cause is vestibular neuritis, an acute inflammation of the vestibular nerve. This condition typically causes sudden, severe vertigo lasting several days, often accompanied by nausea and difficulty standing or walking. Although the acute phase improves spontaneously, many patients experience residual imbalance that benefits significantly from vestibular rehabilitation.

Ménière’s disease presents differently. It is characterized by recurrent episodes of vertigo associated with fluctuating hearing loss, tinnitus, and a sensation of fullness in the ear. The mechanism involves abnormal inner ear fluid dynamics (endolymphatic hydrops). Management requires both medical control of attacks and long-term follow-up.

In some individuals, both vestibular systems are affected, a condition known as bilateral vestibulopathy. These patients do not usually experience spinning episodes, but instead describe chronic unsteadiness and blurred vision during movement (oscillopsia), particularly in darkness or on uneven ground.

Finally, vertigo may rarely originate from the central nervous system, such as the cerebellum or brainstem. Differentiating peripheral (inner ear) from central causes is one of the most important responsibilities of the specialist, as vascular causes may require urgent intervention.

---

How is vertigo properly diagnosed?

Accurate diagnosis is the cornerstone of effective treatment. Imaging alone is not sufficient. In fact, most vestibular diagnoses are clinical and depend on a structured, expert evaluation.

Clinical history

The diagnostic process begins with a detailed history. The timing of symptoms (seconds, hours, or days), the triggers (positional changes or spontaneous onset), and associated features such as hearing changes or headache often guide the diagnosis even before testing begins. Understanding whether symptoms are episodic, acute and prolonged, or chronic and fluctuating allows us to classify the vestibular syndrome accurately.

Basic clinical vestibular examination

A structured bedside examination remains fundamental. Careful observation of eye movements can reveal spontaneous or gaze-evoked nystagmus. Positional maneuvers such as the Dix–Hallpike test help diagnose BPPV. The bedside Head Impulse Test evaluates vestibular function in a simple but powerful way, detecting deficits of the vestibulo-ocular reflex.

Balance testing, including Romberg and dynamic stance assessment, provides information about how the body integrates sensory input. Cerebellar coordination tests help exclude central causes. When performed systematically, this examination frequently allows clear differentiation between peripheral and central vertigo.

Video Head Impulse Test (vHIT)

The video Head Impulse Test is an objective extension of the bedside head impulse examination. Using high-speed cameras and specialized software, it measures the vestibulo-ocular reflex in all six semicircular canals. This allows us to quantify vestibular function, detect unilateral or bilateral deficits, and identify subtle corrective eye movements (covert and overt saccades) that are invisible to the naked eye.

vHIT is particularly valuable in acute vestibular syndromes and in chronic imbalance, as it documents functional recovery or persistent hypofunction over time.

Posturography with virtual reality integration

Posturography evaluates how the brain integrates visual, vestibular, and proprioceptive information to maintain posture. By modifying sensory input in a controlled way, we can identify whether a patient is overly dependent on vision, insufficiently using vestibular input, or demonstrating maladaptive balance strategies.

This objective analysis is especially helpful in chronic dizziness, bilateral vestibular loss, visual motion sensitivity, and persistent postural-perceptual dizziness (PPPD). Beyond diagnosis, it guides individualized rehabilitation planning.

---

Treatment of vertigo

Treatment depends entirely on the cause and the stage of the condition.

When a specific cause is identified and treatable, it is addressed directly. BPPV is resolved with repositioning maneuvers. Ménière’s disease follows a structured medical protocol. Acute vestibular inflammation is managed appropriately and monitored carefully. If a vascular cause is suspected, urgent referral is mandatory.

However, in many cases—particularly after acute events—the main challenge is not ongoing damage, but incomplete central compensation. The brain must reorganize and recalibrate sensory input to restore stable balance. This neuroplastic process can be slow or incomplete without targeted stimulation.

---

3D Virtual Reality Vestibular Rehabilitation

Vestibular rehabilitation is the most effective treatment for persistent imbalance. At Clínica SENT in Granada, we use structured 3D virtual reality–based rehabilitation to enhance recovery.

This approach is not a set of generic exercises. It is a progressive, individualized neuro-retraining program based on objective findings from clinical examination, vHIT, and posturography. Virtual reality environments allow controlled visual motion exposure, adaptation training, sensory reweighting, and postural control exercises that stimulate central compensation more efficiently than traditional methods alone.

The goal is not merely symptom reduction, but restoration of confidence, stability, and functional independence.

---

Why specialized evaluation matters

Vertigo can be benign and easily treatable, chronically disruptive but manageable, or rarely a sign of serious neurological disease. The difference lies in accurate diagnosis and structured follow-up.

A careful clinical examination, supported by objective vestibular testing and evidence-based rehabilitation, provides clarity, safety, and an effective path forward.