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| Diagnosis | Benign paroxysmal positional vertigo (BPPV) | Vestibular neuritis | Labyrinthitis | Meniere’s disease |
| Epidemiology | Can affect people of any age but commonly presents around 50 years. F > M. | Affects previously well young or middle-aged adults. | Affects previously well young or middle-aged adults. | Occurs usually for the first time in people 20 – 60 years of age. |
| Aetiology | Usually idiopathic, particularly in elderly people. Can be precipitated by head injury, ear surgery or following an episode of labyrinthitis. | Often follows a viral infection. | Often follows a viral infection. | Unknown. |
| Pathophysiology | Dislodged otolith particles moving in the semicircular canals. | Inflammation of the vestibular nerve. | Inflammation of the labyrinth and the vestibular nerve. | Thought to be caused by endolymphatic hypertension in the inner ear. |
| Vertigo | Episodic attacks lasting seconds (but may be described as minutes), provoked by moving the head. | Spontaneous onset, lasts days – gradually improves with time. | Spontaneous onset, lasts days – gradually improves with time. | Spontaneous episodic attacks lasting 30 minutes to several hours, can occur in clusters with long remission periods in between. |
| Associated features | Nausea, lightheadedness, imbalance. | Nausea and vomiting. | Nausea and vomiting, sudden hearing loss | Tinnitus, hearing loss, aural fullness. |
| Examination |
Normal at rest. Hallpike |
Spontaneous | Spontaneous | No specific clinical signs |
| findings | manoeuvre demonstrates nystagmus (torsionally and beating towards the lowermost ear). | nystagmus (usually fine horizontal). Positive head impulse test. | nystagmus (usually fine horizontal). Sensorineural deafness. | or diagnostic tests for Meniere’s disease. |
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