• A patient presents to your office complaining of a sensation that the room is spinning around them. These symptoms tend to come on when the patient goes from laying or sitting to standing. The patient denies hearing loss or tinnitus and has no ataxia. On physical exam there is a positive Dix-Hallpike maneuver.
Disease Characteristics
Symptoms Diagnostic Test Treatment
Benign positional vertigo
  • Changes with position
  • Vertigo without hearing loss, tinnitus, or ataxia
  • MRI of internal auditory canal
  • Diagnosis: Dix-Hallpike maneuver
  • Treatment: Epley maneuver 
  • Meclizine
Vestibular neuritis
  • Vertigo without postion changes
  • Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII)
  • Meclizine
  • Acute, self-resolving episode
  • Vertigo
  • Hearing loss
  • Tinnitus
  • Self-limited
  • Meclizine + steroids
Meniere's disease
  • Chronic remitting and relapsing episodes
  • Vertigo
  • Hearing loss
  • Tinnitus in a chronic remitting and relapsing manner
  • Diuretics
  • Salt restriction
  • Unilateral CN VIII ablation (severe cases)
Perilymph fistula
  • History of trauma
  • Vertigo from Trauma
  • Fix damage surgically
Acoustic neuroma
  • Ataxia
  • Neurofibromatosis type II
  • MRI findings
  • Vertigo
  • Hearing loss
  • Tinnitus AND ataxia
  • Surgical intervention
  • A common form of peripheral vertigo
  • Results from a dislodged piece of otolith
    • causes disturbances in the semicircular canals
    • motion can disturb the otolith and improve or exacerbate symptoms
  • Sudden episodic vertigo with head movements   
    • last for seconds
  • Horizontal nystagmus with specific head postures
  • Accompanied by nausea and vomiting
  • Reproduced during Dix-Halpike maneuver
    • patients lies supine and quickly turns head to side
  • Rule out other etiologies with imaging, audiograms, and TSH levels
  • Treat with repositioning exercises (Epley maneuver)
  • Meclizine

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