From the Guidelines
Vestibular neuritis, labyrinthitis, and benign paroxysmal positional vertigo (BPPV) are distinct inner ear disorders causing vertigo, but they differ in their underlying causes, symptoms, and treatments. The key differences between these conditions can be summarized as follows:
- Vestibular neuritis:
- Caused by inflammation of the vestibular nerve
- Sudden onset of severe, constant vertigo lasting days to weeks
- No hearing loss
- Treatment: Supportive care, vestibular suppressants (e.g., meclizine 25-50 mg every 4-6 hours), and vestibular rehabilitation exercises
- Labyrinthitis:
- Inflammation of both the vestibular nerve and cochlea
- Sudden onset of vertigo with associated hearing loss and tinnitus
- Symptoms last days to weeks
- Treatment: Similar to vestibular neuritis, plus possible short course of oral steroids (e.g., prednisone 60 mg daily for 5 days, then taper)
- Benign Paroxysmal Positional Vertigo (BPPV):
- Caused by displaced otoconia in the semicircular canals
- Brief episodes of vertigo triggered by specific head movements
- No hearing loss or other neurological symptoms
- Treatment: Canalith repositioning maneuvers (e.g., Epley maneuver for posterior canal BPPV) Understanding these differences is crucial for accurate diagnosis and appropriate management, as highlighted in the clinical practice guideline for Ménière's disease 1 and the clinical practice guideline for benign paroxysmal positional vertigo (update) 1. Vestibular neuritis and labyrinthitis are typically viral in origin and affect the vestibular system more broadly, while BPPV is a mechanical problem within the inner ear. The presence or absence of hearing loss, duration of symptoms, and triggering factors help distinguish between these conditions.
Some key points to consider when diagnosing and managing these conditions include:
- The importance of a thorough otologic history and physical examination to evaluate for neurologic, otologic, and other causes of vertigo 1
- The use of specific diagnostic tests, such as the Dix-Hallpike test and supine roll test, to diagnose BPPV 1
- The role of patient education and shared decision making in the management of BPPV 1
- The potential for BPPV to be treated with canalith repositioning maneuvers, with a high success rate and minimal risk of adverse effects 1
- The importance of follow-up and reassessment to confirm symptom resolution and evaluate for underlying conditions that may be contributing to the patient's symptoms 1.
From the Research
Vestibular Neuritis (VN) vs Labyrinthitis and Benign Paroxysmal Positional Vertigo (BPPV)
The key differences between VN, Labyrinthitis, and BPPV are:
- Clinical Presentation: VN is characterized by sudden, unilateral vestibular loss, while BPPV is characterized by brief, episodic vertigo triggered by head movements 2, 3.
- Symptoms: VN typically presents with abrupt, true-whirling vertigo lasting for more than 24 hours, without cochlear symptoms or other neurological symptoms and signs 4. In contrast, BPPV is characterized by brief symptoms of vertigo secondary to head and body movements 3.
- Diagnosis: VN is diagnosed using various tests such as the head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential test 4. BPPV is diagnosed using maneuvers to elicit symptoms and nystagmus, and the nystagmus pattern is used to determine the location of the wayward crystals in the semicircular canals 3.
- Treatment: VN treatment includes symptomatic therapy, specific drug therapy, and vestibular rehabilitation therapy 4. BPPV is treated using different maneuvers to reposition the wayward crystals in the semicircular canals 3.
- Etiology: The cause of VN remains unclear, but it is thought to be related to viral infection or ischemia of the anterior vestibular artery 4. BPPV is caused by wayward crystals in the semicircular canals of the inner ear 3.
Comparison of VN and BPPV
Some key differences between VN and BPPV are: