Snapshot A patient presents to your office complaining of a sensation that the room is spinning around them. These symptoms tend to come on when the patient goes from laying or sitting to standing. The patient denies hearing loss or tinnitus and has no ataxia. On physical exam there is a positive Dix-Hallpike maneuver. Overview Disease Characteristics Symptoms Diagnostic Test Treatment Benign positional vertigo Changes with position Vertigo without hearing loss, tinnitus, or ataxia MRI of internal auditory canal Diagnosis: Dix-Hallpike maneuver Treatment: Epley maneuver Meclizine Vestibular neuritis Vertigo without postion changes Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII) Meclizine Labyrinthitis Acute, self-resolving episode Vertigo Hearing loss Tinnitus Self-limited Meclizine + steroids Meniere's disease Chronic remitting and relapsing episodes Vertigo Hearing loss Tinnitus in a chronic remitting and relapsing manner Diuretics Salt restriction Unilateral CN VIII ablation (severe cases) Perilymph fistula History of trauma Vertigo from Trauma Fix damage surgically Acoustic neuroma Ataxia Neurofibromatosis type II MRI findings Vertigo Hearing loss Tinnitus AND ataxia Surgical intervention Introduction A common form of peripheral vertigo Results from a dislodged piece of otolith causes disturbances in the semicircular canals motion can disturb the otolith and improve or exacerbate symptoms Presentation Sudden episodic vertigo with head movements last for seconds Horizontal nystagmus with specific head postures Accompanied by nausea and vomiting Evaluation Reproduced during Dix-Halpike maneuver patients lies supine and quickly turns head to side Rule out other etiologies with imaging, audiograms, and TSH levels Treatment Treat with repositioning exercises (Epley maneuver) Meclizine