Vertigo differentials

Symptoms: Episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness.
Etiology: Unclear, but linked to abnormal fluid dynamics in the inner ear.
Age Groups: Typically adults between 40 and 60 years.
Red Flags: Progressive hearing loss, neurological symptoms.
Investigations: Audiometry, Electronystagmography (ENG), Magnetic Resonance Imaging (MRI) to rule out other causes.
Treatment: Low salt diet, diuretics, vestibular suppressants (during acute episodes), intratympanic steroids or gentamicin, and, in severe cases, surgical interventions like endolymphatic sac decompression.

Symptoms: Sudden, severe, and prolonged vertigo, nausea, and vomiting, often without hearing loss.
Etiology: Likely viral infection of the vestibular nerve.
Age Groups: Common in adults, rarely in children.
Red Flags: Focal neurological deficits, lack of improvement over time.
Investigations: Clinical diagnosis primarily; MRI may be used to rule out central lesions.
Treatment: Vestibular suppressants and antiemetics for acute symptoms, corticosteroids, and vestibular rehabilitation.

Symptoms: Vertigo, hearing loss, and tinnitus.
Etiology: Viral or bacterial infection affecting the labyrinth.
Age Groups: Can occur at any age but more common in adults.
Red Flags: Persistent hearing loss, neurological deficits.
Investigations: Audiometry, MRI or CT to exclude other causes.
Treatment: Antibiotics for bacterial cases, steroids, vestibular suppressants, antiemetics, and vestibular rehabilitation.

Symptoms: Brief episodes of vertigo triggered by head movements, nystagmus.
Etiology: Dislodged otoliths in semicircular canals.
Age Groups: Commonly affects older adults, but can occur at any age.
Red Flags: Vertigo not triggered by position changes, persistent symptoms.
Investigations: Dix-Hallpike test, Roll test.
Treatment: Epley or Semont maneuvers for canalith repositioning, vestibular rehabilitation exercises.

Symptom Duration: Vestibular Neuritis and Labyrinthitis typically have more prolonged symptoms compared to BPPV. Meniere’s disease presents with episodic symptoms.
Hearing Involvement: Hearing loss is a key feature in Meniere’s disease and Labyrinthitis but not in Vestibular Neuritis or BPPV.
Progression and Recurrence: Meniere’s disease can progress with time, leading to permanent hearing loss. BPPV may recur even after successful treatment.
Red Flags: Any neurological symptoms (like weakness, double vision, slurred speech), persistent or worsening symptoms, or hearing loss warrant further investigation to rule out more serious conditions like stroke or brain tumors.

Symptom Control: Acute vertigo can be managed with vestibular suppressants (like meclizine) and antiemetics.
Rehabilitation: Vestibular rehabilitation exercises are crucial in all these conditions for long-term improvement.
Specific Treatments: BPPV responds well to repositioning maneuvers, whereas Meniere’s might require more complex treatment strategies including lifestyle changes and possibly surgery.