Ask the Doctor: Long-lasting vertigo

“My vertigo episode started with a bad spinning sensation and vomiting and I had to go to the hospital. The next day I was allowed home after tests for a stroke which were all clear. I was given a steroid injection, and an Epley Maneuver was also performed in hospital on the second day. I was not too bad for a couple of weeks after that, until these last 3 weeks when my Doctor put me on Prednisolone, but it seems to make it worse. I tried to wean off it for a day, but it returned with a vengeance the next day. I sleep well at night though. “

Vertigo due to BPPV usually resolves quickly with maneuvers.  Spells that result in hospitalization are worse than typical BPPV and may have nothing to do with misplaced crystals.  If you are not dizzy in bed, but feel spinning mostly when up and about, this is not as likely to be BPPV and maneuvers may not help. 

If there is a sudden loss of balance function in one ear, that will cause the room to shift or spin, often with vomiting.  This feeling is worse for the first three days or so, and then declines gradually over the next 6 weeks.  Prednisone, an anti-inflammatory drug, is often used and can be very helpful.  Many losses of balance function are caused by a viral infection that strikes the nerve to the ear, causing swelling.  This can be so severe that the nerve is damaged.  By reducing the inflammation and swelling, the nerve can be preserved. 

If the vertigo goes completely away and then returns days or weeks later, this can indicate a damaging inner ear disease that may be progressive.  Sometimes these inner ear disorders result in BPPV, so if there are symptoms when lying down, maneuvers can be helpful in addition to more complex treatments.

The best way to find out if the nerve is damaged is to be evaluated by an ENT or other experienced provider.  A test, VNG (videonystagmography), can determine how much function has been lost.  If there is a loss of function, an MRI needs to be done to ensure that the problem is not due to a tumor or other damaging central process.