Vertigo is a sensation of illusory movement—most often a spinning sensation—of oneself or the surroundings.

It is not simply a feeling of lightheadedness: vertigo indicates an imbalance in the vestibular system, which is involved in controlling balance, posture, and visual stability.

Understanding its cause allows for tailored treatment and helps prevent it from becoming chronic.

1. How does balance work?

Maintaining balance relies on the integration of three sensory systems:

• Vestibular system (inner ear)

• Visual system

• Proprioceptive system (muscles and joints)

This information is analyzed by:

• The vestibular nuclei of the brainstem

• The cerebellum

• The cerebral cortex

👉 Vertigo occurs when there is a discrepancy between this information.

2. Peripheral vertigo (the most common type)

Peripheral vertigo results from damage to the inner ear or the vestibular nerve.

a) Benign paroxysmal positional vertigo (BPPV)

It is caused by the abnormal displacement of otoliths in the semicircular canals.

➡️ The vestibular receptors are stimulated inappropriately, causing brief episodes of vertigo during changes in position.

b) Labyrinthine disorders

• Vestibular neuritis

• Endolymphatic hydrops (Ménière’s disease)

• Ischemia or drug toxicity

These conditions cause an imbalance in activity between the two inner ears, resulting in an intense sensation of spinning.

3. Vertigo of central origin

Less common, central vertigo is associated with damage to:

• The brainstem

• The cerebellum

• The central vestibular pathways

It may be associated with:

• Stroke

• Multiple sclerosis

• Vestibular migraine

• Tumors

In these cases, vestibular information processing is impaired even if the inner ear is intact.

4. Sensory conflict and chronic instability

A conflict between the following types of information:

• Visual

• Vestibular

• Proprioceptive

Can lead to:

• A sensation of floating

• Imbalance

• Persistent instability

• Visual-dependent vertigo

This mechanism explains certain forms of chronic vertigo, even in the absence of active lesions.

5. Stress, anxiety, and vertigo: a vicious cycle

The vestibular system is closely connected to the limbic system (emotions).

Stress can:

• Amplify the perception of vertigo

• Increase hypervigilance

• Hinder the brain’s compensatory mechanisms

A vicious cycle sets in:

Vertigo → anxiety → hypervigilance → increased vertigo

Treatment must therefore address the emotional aspect.

6. Vestibular compensation: a key mechanism

After vestibular damage, the brain initiates central compensation through neural plasticity.

However, certain factors slow down this adaptation:

• Excessive immobilization

• Chronic stress

• Sleep disorders

• Visual or proprioceptive deficits

Support aimed at promoting neurosensory balance can be helpful during this phase.

In line with this holistic approach, specific formulas such as Audistim Équilibre have been developed to support vestibular function and the adaptive mechanisms involved in postural stability.

They are part of a complementary approach, used alongside ENT evaluations and vestibular rehabilitation exercises when these are necessary.