Differential Diagnosis for Vertigo with Tinnitus
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, and it can be associated with tinnitus. It's a common cause of vertigo and often presents with auditory symptoms.
Other Likely Diagnoses
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, leading to episodes of vertigo, tinnitus, hearing loss, and ear fullness. The combination of vertigo and tinnitus is a hallmark of this condition.
- Vestibular Migraine: Although more commonly associated with headache, vestibular migraines can cause vertigo and may also include tinnitus among their symptoms. They are a significant consideration in patients with a history of migraines.
- Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause vertigo, tinnitus, and hearing loss. It often follows a viral infection.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): While less common, vertigo can be a presenting symptom of a stroke or TIA, especially in the posterior circulation. Tinnitus can also occur, particularly if the stroke affects auditory pathways. Missing this diagnosis can be catastrophic.
- Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including vertigo and tinnitus, due to lesions in the central nervous system affecting balance and auditory pathways.
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, tinnitus, and hearing loss. Early detection is crucial for effective management.
Rare Diagnoses
- Ototoxicity: Certain medications can damage the inner ear, leading to vertigo and tinnitus. This is a rare but important consideration in patients on potentially ototoxic drugs.
- 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, including autophony and sound-induced vertigo.
- Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, including vertigo and tinnitus, often associated with systemic vasculitis.