Meniere’s disease, Labyrinthitis, Vestibular Neuritis, and Acoustic Neuroma: How to Spot the Difference

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Meniere's disease, Labyrinthitis, Vestibular Neuritis

Meniere’s disease, Labyrinthitis, Vestibular Neuritis, and Acoustic Neuroma: How to Spot the Difference

Stephen Pasquini PA-C

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Ménière's disease, labyrinthitis, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and acoustic neuroma are all causes of vertigo and are included on the NCCPA PANCE/PANRE EENT blueprint and family medicine rotation exam blueprints.

It is important to be able to differentiate quickly between these five causes of vertigo as they are common exam questions with a significant overlap that exam writers leverage while creating high-quality clinical vignettes.

Let's take a quick look at how patient presentations will differ among these conditions and identify the key differences so that you can quickly make the correct diagnosis.

How to Differentiate Between Meniere's disease, Labyrinthitis, Vestibular Neuritis, and Acoustic Neuroma

  • Labyrinthitis = hearing loss + continuous vertigo + URI
  • Vestibular neuritis = No hearing loss or tinnitus + vertigo + URI
  • Meniere's disease = hearing loss + episodic vertigo + NOT associated with URI
  • Benign paroxysmal positional vertigo = No hearing loss or tinnitus + episodic vertigo with position changes
  • Acoustic neuroma = Unilateral hearing loss, insidious onset vertigo and ataxia +/- facial numbness
Labyrinthitis is associated with CONTINUOUS vertigo along with hearing loss +/- tinnitus and is usually associated with an upper respiratory infection this differentiates it from Meniere’s syndrome which is EPISODIC and not typically associated with a viral infection. The features of acute labyrinthitis are similar to those of vestibular neuronitis, except labyrinthitis includes significant sensorineural hearing loss which is NOT present in vestibular neuronitis. Benign paroxysmal positional vertigo can be differentiated by its association with position changes. While acoustic neuroma will present with unilateral hearing loss, an insidious onset, ataxia, and +/-  facial numbness as the acoustic neuroma on the vestibulocochlear nerve puts pressure on the facial nerve.

Overview:

Disease Characteristics Symptoms Diagnostic Test Treatment
Benign positional vertigo Changes with position Vertigo without hearing loss, tinnitus, or ataxia MRI of the internal auditory canal Diagnosis: Dix-Hallpike maneuver

Treatment: Epley maneuver

Meclizine
Vestibular neuritis Vertigo without position changes Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII) associated with URI Meclizine
Labyrinthitis Acute, self-resolving episode Continuous Vertigo

Hearing loss

Tinnitus

Self-limited

Associated with URI

 Meclizine + steroids
Meniere's disease Chronic remitting and relapsing episodes Episodic Vertigo

Hearing loss

Tinnitus and chronic remitting and relapsing manner

Not associated with URI

 Diuretics

Salt restriction

Unilateral CN VIII ablation (severe cases)
Acoustic neuroma Ataxia

Neurofibromatosis type II

MRI findings

Facial numbness

 Vertigo

Unilateral hearing loss

Tinnitus AND ataxia

 Surgical intervention

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