Peripheral vertigo stems from a difference in activity between the two ears, which leads to discordance in the messages sent to the brain. This, in turn, is interpreted as movement. There are several causes of peripheral vertigo.

Labyrinthitis

This is inflammation of the rigid bony outer wall of the inner ear in the temporal bone. The condition usually follows a viral infection and may feature additional symptoms such as hearing loss, headaches, tinnitus, effusion, otorrhoea (discharge from the ear), otalgia (ear pain) and disturbed vision.

Vestibular neuronitis

This is similar to labyrinthitis and is also usually due to a viral infection, but the inflammation is confined to the vestibular nerve. Symptoms are as labyrinthitis although often worse upon waking. Hearing loss and tinnitus are absent.

Benign paroxysmal positional vertigo (BPPV)

BPPV stems from small particles of calcium carbonate (otoliths) that normally balance on nerve endings in the inner ear becoming dislodged and moving into the semi-circular canals. As a result, certain head movements cause the now free-floating otoliths to brush against hair cells which send a signal to the brain that is interpreted as vertigo. This can occur spontaneously, particularly in older people, but may be precipitated by trauma to the head (including ear surgery) or following labyrinthitis.

Ménière’s disease

This condition is thought to be due to raised pressure in the inner ear, possibly as the result of an infection, allergy, immune system disorder, impaired fluid drainage, head injury or migraine, but there may also be a genetic link. Dizziness, tinnitus, nausea, vomiting, a feeling of pressure within the ear and hearing loss commonly accompany vertigo, usually starting in one ear but often spreading to both. The attack normally lasts two to three hours, but it can take a couple of days for the symptoms to disappear completely, during which time the sufferer is likely to feel very tired. Episodes may be clustered or be punctuated by weeks, months or even years.