Benign Paroxysmal Positional Vertigo vs Vestibular Neuritis and Labyrinthitis
Benign Paroxysmal Positional Vertigo and Vestibular Neuritis and Labyrinthitis 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 Vestibular Neuritis and Labyrinthitis at a glance
- Benign Paroxysmal Positional Vertigo: Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning.
- Vestibular Neuritis and Labyrinthitis: Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo.
Keep comparing — start your free trial
You've used your 2 free previews. Create your free account to see the full Benign Paroxysmal Positional Vertigo vs Vestibular Neuritis and Labyrinthitis comparison — plus all 514 diagnosis outlines, 6,400+ board-style questions, and an AI tutor. Your 7-day free trial includes everything, no credit card required.
Side-by-side comparison
| Feature | Benign Paroxysmal Positional Vertigo | Vestibular Neuritis and Labyrinthitis |
|---|---|---|
| At a glance | Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning. | Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo. |
| 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… | AVS with peripheral HINTS pattern + recent URI + unidirectional nystagmus suppressed by fixation.; Sudden severe constant vertigo lasting hours to days, often peaking on day 1-2; Nausea, vomiting, profuse diaphoresis; Gait instability and falls toward the affected side; Hearing loss and tinnitus only in labyrinthitis (NOT in neuritis);… |
| 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… | Bárány Society 2022: acute or subacute onset of spinning vertigo, lasting at least 24 h, with spontaneous horizontal nystagmus and unilateral vestibular hypofunction (head impulse or caloric); no acute central neurologic signs; vestibular neuritis if hearing spared, labyrinthitis if cochlear involvement.; Generally clinical diagnosis;… |
| 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,… | HINTS exam at bedside is more sensitive than early MRI for posterior stroke in AVS; MRI brain with DWI within 24-72 h if any central features, vascular risk factors, age >60, severe imbalance disproportionate to nystagmus, or any HINTS findings suggesting central etiology (INFARCT mnemonic — Impulse Normal, Fast-phase Alternating,… |
| 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… | Acute symptomatic relief (24-72 h only, then taper): meclizine 25-50 mg q6-8h, dimenhydrinate, promethazine, lorazepam, ondansetron; Hydration — IV fluids if vomiting precludes oral intake; Methylprednisolone 100 mg/day PO with taper over 3 weeks — shortens recovery and improves vestibular function recovery in vestibular neuritis (per… |
Drill Benign Paroxysmal Positional Vertigo vs Vestibular Neuritis and Labyrinthitis questions on FirstPassPA
Turn this comparison into retention. 6,400+ board-style questions with an AI tutor that explains every answer — free to start, no card required.
Start studying free → Try today's free questionEducational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.