Snapshot A 15-year-old girl presents to her physician with vertigo. She claims that at times she feels as if the room is spinning around her. Upon further conversation you learn that she also has episodes of hearing and tinnitus as well that are associated with the vertigo. 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 Dix-Hallpike 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 that results from dilation of membranous labyrinth due to excess endolymph in the cochlear Causes include head trauma syphilis Presentation Symptoms episodic vertigo tinnitus sensorineural hearing loss nausea ear "fullness" Evaluation Diagnosis by audiometry shows low frequency pure-tone hearing loss fluctuates in severity Differential Benign positional vertigo, acute peripheral vestibulopathy, otosclerosis, cerebropontine angle tumor, acoustic neuropathy. Treatment Episodes resolve within hours to days Non-pharmacologic treatment low salt diet avoidance of alcohol, nicotine, caffeine Pharmacologic treatment thiazides anticholinergics antihistamines In refractory cases surgical decompresssion may be necessary labyrinthectomy