Ménière Disease vs Vestibular Neuritis and Labyrinthitis
Ménière Disease 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.
Ménière Disease vs Vestibular Neuritis and Labyrinthitis at a glance
- Ménière Disease: Inner-ear disorder of recurrent vertigo episodes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness.
- Vestibular Neuritis and Labyrinthitis: Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo.
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Side-by-side comparison
| Feature | Ménière Disease | Vestibular Neuritis and Labyrinthitis |
|---|---|---|
| At a glance | Inner-ear disorder of recurrent vertigo episodes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness. | Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo. |
| Classic presentation | 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… | 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 | 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,… | 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 | 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… | 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 | 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;… | 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… |
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