Snapshot A patient presents with hearing loss and tinnitus that began yesterday as well as a sensation that the room was "spinning" around them. On physical exam a horizontal nystagmus is observed. Overview Disease Characteristics Symptoms Diagnostic Test Treatment Benign positional vertigo Changes with position Diagnosis: Dix-Hallpike maneuver Vertigo without hearing loss, tinnitus, or ataxia MRI of internal auditory canal 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 form of peripheral vertigo Preceded by viral respiratory illness History of a recent viral infection is common Presentation Symptoms acute onset of severe, contiguous vertigo nausea vomiting tinnitus hearing loss Physical exam horizontal nystagmus toward the unaffected ear Evaluation Diagnosis is clinical May have a positive Romberg test fall to the side of the affected ear Rule out other etiologies with imaging, audiograms, TSH levels Differential Benign positional vertigo, acute peripheral vestibulopathy, otosclerosis, cerebropontine angle tumor, acoustic neuropathy Treatment Meclizine Bed rest and avoiding rapid head movements. If bacterial labyrinthitis is suspected then consider antibiotics Prognosis, Prevention, and Complications Lasts days to weeks