It can be hard to figure out which ear is the source of the vertigo you are experiencing. It’s possible to do this if your vertigo has one of these characteristics:
- You can set off the vertigo by making a certain head movement
- You can see the room spin most of the time
- You notice something wrong with one ear, like hearing loss, ringing or a painful skin rash.
If you can set off the vertigo with movement, you can use the movement as a clue. If the vertigo comes on when lying down, try lying down quickly with the right ear down, and again a few minutes later with the left ear down. In the disorder BPPV, the downward ear when an attack happens is usually the one with the problem. You can then choose to use the half somersault maneuver for the bad ear. If both sides seem bad, it could mean BPPV in both ears, but this makes it much harder to be certain. Trying maneuvers for both sides, 15 minutes apart, can help. There are rare cases of horizontal canal BPPV where the bad ear is the up ear, so if your treatment maneuvers don’t work, you should see a provider for additional help.
If your world spins when you are upright and turning your head, start seated with your head centered and turn briskly to your right while focusing on an object in front of you (writing on a computer screen is particularly good as a target). Do you see the world shift or blur suddenly? This indicates the right ear is the problem. Center your head, then turn quickly to the left, watching for any shifting or blurring. Seeing a shift that is worse to one side than the other is a sign the worst side is the affected one.
If you can see the room spin most of the time, this usually indicates a problem that is more severe than BPPV, such as damage to an ear from a viral infection. You may have nystagmus, a drifting of the eyes that can be seen by others as a fine twitching or jiggling of your eyes. First, pay attention to the direction the room seems to be shifting. Go in a dark room and look at a small light, like the one on your phone. You may see it going across your field of vision over and over, as if shifting and resetting. If it’s spinning horizontally and is heading right to left, that is more likely to indicate the right ear is affected. Spinning left to right is more likely to be the left ear. There are cases where this doesn’t hold up, though. If that happens, do the seated head turns above and look for blurring. This is a more accurate way to find out the side of the problem.
If the spinning is circular like you’re in a washing machine looking out, clockwise or counterclockwise, it can’t be reliably used to determine which ear is affected. You’ll need to see an expert for that.
If you notice something wrong with one ear that is the simplest way to determine the cause of the vertigo. An ear that loses hearing or has a ringing sound is usually the ear causing the vertigo, even if the ringing or hearing loss are intermittent. You can compare the hearing in each ear by rubbing your fingers next to each ear; it may sound much louder in the good ear than the bad one. Tinnitus—ringing sounds—can be very faint or quite loud, and can be very low like a waterfall or high pitched. Having this in just one ear indicates that your vertigo probably comes from that ear.
Some viral infections cause a painful blistering rash on the ear or in the ear canal, or even on the side of the face or head. If vertigo happens around the time of the rash, it will be coming from the ear on the same side as the rash.
If you can identify the problem ear, this can help your provider figure out a treatment. There are also tests, like VNG, that can determine which ear is the problem if you don’t have enough clues to figure it out.
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