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… | Recurrent spontaneous vertigo + unilateral low-frequency hearing loss + tinnitus + aural fullness.; Episodic spontaneous vertigo lasting 20 min to 12 h… |
| Workup / key labs | Bárány Society criteria: characteristic positional vertigo + positional nystagmus on appropriate maneuver (Dix-Hallpike for posterior canal, head-roll for… | 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… |
| Imaging | Imaging NOT required for classic BPPV; MRI brain with brainstem/IAC views if: atypical features (continuous vertigo, neurologic findings, central nystagmus,… | Pure-tone and speech audiometry — low/mid-frequency SNHL, often fluctuating; word recognition typically preserved early; MRI with gadolinium of internal… |
| First-line treatment | Canalith repositioning maneuvers — definitive treatment:; Epley maneuver for posterior canal BPPV (success rate 60-90% per attempt; may repeat); Semont… | Low-sodium diet (<2 g/day), caffeine and alcohol reduction, smoking cessation; Thiazide diuretic (hydrochlorothiazide, often combined with triamterene) or… |
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