What are the differences between Vestibular Neuritis, Labyrinthitis, and Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

Vestibular neuritis, labyrinthitis, and benign paroxysmal positional vertigo (BPPV) are distinct inner ear disorders with different causes and characteristics, and accurate diagnosis is crucial for proper treatment and management of these conditions. The key differences between these conditions are:

• Vestibular neuritis: inflammation of the vestibular nerve, causing sudden, severe vertigo lasting days to weeks, with no hearing loss, and often viral in origin 1
• Labyrinthitis: inflammation of both the vestibular nerve and cochlea, causing vertigo, hearing loss, and tinnitus, and can be viral or bacterial 1
• BPPV: caused by displaced calcium crystals in the inner ear, resulting in brief episodes of vertigo triggered by head position changes, with no hearing loss or other symptoms, and treated with specific repositioning maneuvers 1 For vestibular neuritis and labyrinthitis, treatment may include vestibular suppressants like meclizine 25mg every 8 hours for a few days, along with gradual vestibular rehabilitation exercises 1. BPPV is best treated with the Epley maneuver or other repositioning techniques performed by a healthcare provider 1. Understanding these distinctions is crucial for proper diagnosis and treatment, and the presence or absence of hearing loss, duration of symptoms, and triggering factors help differentiate these conditions 1.

Some key points to consider in the diagnosis and management of these conditions include:

• The use of the Dix-Hallpike test and supine roll test to diagnose BPPV 1
• The importance of patient education and shared decision making in the management of BPPV 1
• The need for careful evaluation and management of patients with vestibular neuritis and labyrinthitis to prevent long-term complications and improve quality of life 1
• The role of vestibular rehabilitation exercises in the treatment of vestibular neuritis and labyrinthitis 1

From the Research

Vestibular Neuritis

• Characterized by abrupt true-whirling vertigo lasting for more than 24 hours, with no presence of cochlear symptoms and other neurological symptoms and signs 2
• Cause remains unclear, but may be due to viral infection of the vestibular nerve or ischemia of the anterior vestibular artery 2
• Diagnosis is made through various tests such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test 2
• Treatment options include symptomatic therapy, specific drug therapy, and vestibular rehabilitation therapy 2

Labyrinthitis

• Not directly mentioned in the provided studies, but can be inferred to be a disorder of the inner ear that can cause vertigo and hearing loss
• May be related to vestibular neuritis, but distinct in its effects on the inner ear

Benign Paroxysmal Positional Vertigo (BPPV)

• Characterized by brief spells of spinning vertigo triggered by head movement 3, 4
• Caused by otoconia overlying the otolith membrane falling into the semicircular canals 4
• Diagnosed by a positional test, which triggers paroxysmal positional nystagmus in the plane of the affected semicircular canal 4
• Can be treated with canalith repositioning procedures 5
• May be secondary to vestibular neuritis, in which case it presents with distinct epidemiological and clinical features 6

Comparison of Vestibular Neuritis, Labyrinthitis, and BPPV

• Vestibular neuritis and BPPV are both peripheral vestibular disorders, but have distinct causes and symptoms 2, 3, 4
• Labyrinthitis is not directly mentioned in the provided studies, but may be related to vestibular neuritis and BPPV in its effects on the inner ear
• BPPV can be secondary to vestibular neuritis, and presents with distinct features in this case 6