Differential Diagnosis
- Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): The patient's symptoms of vertigo lasting 5 minutes, self-resolving, and triggered by laying on the right side, along with nystagmus, are classic for BPPV. The brief episodes of vertigo and the specific trigger of positional change strongly support this diagnosis.
- Other Likely diagnoses
- Meniere's Disease: This condition is characterized by vertigo, tinnitus, hearing loss, and ear fullness. The patient's vertigo, right ear pain, and pressure headaches could be consistent with Meniere's, although the absence of reported tinnitus or hearing loss makes it less likely than BPPV.
- Labyrinthitis: Inflammation of the inner ear can cause vertigo, ear pain, and sometimes nystagmus. The patient's symptoms of vertigo, ear pain, and nystagmus could fit this diagnosis, but the episodic nature and specific triggers are more suggestive of BPPV.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Posterior Circulation Stroke: Although less likely given the episodic and self-resolving nature of the vertigo, a stroke in the posterior circulation (including the cerebellum or brainstem) can present with vertigo, nystagmus, and headache. The potential for devastating consequences if missed makes considering this diagnosis crucial.
- Vestibular Migraine: Some patients with migraines can experience vertigo, which may be accompanied by headache and could potentially cause nystagmus. While not typically life-threatening, missing this diagnosis could lead to inappropriate treatment and significant morbidity.
- Rare diagnoses
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain can cause vertigo, ear pain, and sometimes nystagmus, along with hearing loss and tinnitus. The absence of reported hearing loss or tinnitus and the specific pattern of vertigo make this less likely.
- Perilymphatic Fistula: An abnormal connection between the inner and middle ear can cause vertigo, ear fullness, and hearing loss, often triggered by changes in pressure. The patient's symptoms of vertigo and ear pain could fit, but this condition is rare and usually associated with more profound auditory symptoms.