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
|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
|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
Associated with URI
|Meclizine + steroids|
|Meniere's disease||Chronic remitting and relapsing episodes||Episodic Vertigo
Tinnitus and chronic remitting and relapsing manner
Not associated with URI
Unilateral CN VIII ablation (severe cases)
Neurofibromatosis type II
Unilateral hearing loss
Tinnitus AND ataxia