Benign Paroxysmal Positional Vertigo vs Ménière Disease
Benign Paroxysmal Positional Vertigo and Ménière Disease are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Benign Paroxysmal Positional Vertigo vs Ménière Disease at a glance
- Benign Paroxysmal Positional Vertigo: Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning.
- Ménière Disease: Inner-ear disorder of recurrent vertigo episodes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness.
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Side-by-side comparison
| Feature | Benign Paroxysmal Positional Vertigo | Ménière Disease |
|---|---|---|
| At a glance | Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning. | Inner-ear disorder of recurrent vertigo episodes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness. |
| Classic presentation | Dix-Hallpike maneuver provoking transient upbeat-torsional nystagmus with concurrent vertigo, latency, and fatigability.; Brief (<60 seconds) episodes of true vertigo triggered by changes in head position: rolling over in bed, getting in/out of bed, looking up, bending forward; Nausea, occasionally vomiting; Postural unsteadiness… | Recurrent spontaneous vertigo + unilateral low-frequency hearing loss + tinnitus + aural fullness.; Episodic spontaneous vertigo lasting 20 min to 12 h (rarely up to 24 h); Fluctuating low- to mid-frequency sensorineural hearing loss, typically unilateral; Roaring or low-pitched tinnitus that may worsen during episodes; Aural fullness… |
| Workup / key labs | Bárány Society criteria: characteristic positional vertigo + positional nystagmus on appropriate maneuver (Dix-Hallpike for posterior canal, head-roll for horizontal canal), with timing and direction consistent with the involved canal, and exclusion of central causes.; None routinely indicated for typical BPPV; Consider vitamin D and… | Definite Ménière (Bárány/AAO-HNS 2015): ≥2 episodes of spontaneous vertigo lasting 20 min to 12 h + audiometrically documented low- to mid-frequency SNHL in the affected ear before, during, or after an episode + fluctuating aural symptoms (hearing loss, tinnitus, fullness) in the affected ear + no better explanation.; TSH, CBC,… |
| Imaging | Imaging NOT required for classic BPPV; MRI brain with brainstem/IAC views if: atypical features (continuous vertigo, neurologic findings, central nystagmus, persistent symptoms after repositioning, unilateral hearing loss, abnormal HINTS) → exclude posterior circulation stroke or cerebellopontine angle mass; HINTS exam (Head Impulse,… | Pure-tone and speech audiometry — low/mid-frequency SNHL, often fluctuating; word recognition typically preserved early; MRI with gadolinium of internal auditory canals — exclude vestibular schwannoma and central pathology; Vestibular testing (videonystagmography, caloric, VEMPs) as indicated; Electrocochleography — elevated SP/AP ratio… |
| First-line treatment | Canalith repositioning maneuvers — definitive treatment:; Epley maneuver for posterior canal BPPV (success rate 60-90% per attempt; may repeat); Semont (liberatory) maneuver — alternative for posterior canal; Lempert (BBQ roll) or Gufoni maneuver for horizontal canal BPPV; Provide patient education and at-home exercises (Brandt-Daroff… | Low-sodium diet (<2 g/day), caffeine and alcohol reduction, smoking cessation; Thiazide diuretic (hydrochlorothiazide, often combined with triamterene) or acetazolamide — to reduce endolymph volume; Vestibular suppressants for acute attacks: meclizine, dimenhydrinate, promethazine, lorazepam, prochlorperazine — limit to acute use;… |
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