Labyrinthitis: This is an inner ear infection that can cause vertigo, hearing loss, and tinnitus. It is a common complication of middle ear infections and can directly affect the balance structures of the inner ear, leading to vertigo.

Vestibular Neuritis: An inflammation of the vestibular nerve, which can be caused by a viral infection, leading to severe vertigo. It might be considered in the context of a middle ear infection if the infection has spread or if the patient has a viral infection.
Benign Paroxysmal Positional Vertigo (BPPV): Although not directly caused by a middle ear infection, BPPV can cause vertigo and might be considered if the patient's vertigo is triggered by specific head movements.
Middle Ear Effusion: Fluid buildup in the middle ear can cause a feeling of fullness or pressure and might lead to vertigo in some cases, especially if it affects the Eustachian tube function and middle ear pressure regulation.

Meningitis: Although rare, meningitis is a potentially life-threatening condition that can cause vertigo among other symptoms like fever, headache, and stiff neck. It could be a complication of a severe middle ear infection spreading to the meninges.
Stroke or Transient Ischemic Attack (TIA): Vertigo can be a symptom of a stroke or TIA, especially if it's accompanied by other neurological deficits. It's crucial to rule out these conditions due to their urgency and potential for severe outcomes.
Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. While not directly related to middle ear infections, it's a critical diagnosis not to miss due to its implications for treatment and prognosis.

Syphilis: In its late stages, syphilis can cause a variety of neurological symptoms, including vertigo. It's a rare cause but should be considered in patients with risk factors or unexplained vertigo.
Autoimmune Inner Ear Disease: A rare condition where the immune system attacks the inner ear, leading to vertigo, hearing loss, and sometimes tinnitus. It might be considered in patients with vertigo and a history of autoimmune disorders.
Superior Semicircular Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior semicircular canal, leading to vertigo and hearing symptoms. It's a rare cause of vertigo but could be considered in patients with characteristic symptoms and findings on imaging.