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Ménière’s Disease

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7 Table 4. Common Causes of Vertigo/Dizziness and Their Differentiating Features from MD Condition Clinical Presentation Differentiation from MD Autoimmune (e.g., multiple sclerosis) Oen progressive fluctuating bilateral hearing loss that is steroid responsive. May present with vision, skin, and joint problems Benign Paroxysmal Positional Vertigo (BPPV) Positional vertigo lasting less than a minute (i.e., seconds). Not associated with hearing loss, tinnitus, or aural fullness; short duration of vertigo spells. Infectious (e.g., Lyme disease) Viral (i.e. adenovirus) or bacterial (e.g., staph/strep); can lead to complete hearing loss and vestibular crisis event with prolonged vertigo and/or hearing loss. Losses are oen permanent and do not fluctuate. Can present with severe otalgia and fever. Otosyphilis Sudden, unilateral or bilateral, sensorineural, fluctuating hearing loss, tinnitus and/or vertigo. Vertigo attacks not typically associated with aural symptoms immediately before or aer attacks. Stroke/ Ischemia Vertigo may last for minutes with nausea, vomiting, severe imbalance. May also include visual blurring and drop attacks. Insults are oen permanent and do not fluctuate. May be comorbid with dysphagia, dysphonia, or other neurologic symptoms and signs. Usually no associated hearing loss, tinnitus. Vestibular Migraine Presents with attacks lasting hours but can also present with attacks lasting minutes or >24 hours. Timing of attacks may be shorter or longer than MD. Hearing loss less likely. Patients oen have a migraine history; more photophobia than visual aura. Vestibular Schwannoma May present with vertigo. Majority present with chronic imbalance, asymmetric hearing loss, and tinnitus. Chronic imbalance more likely than profound episodic vertigo. Hearing loss does not typically fluctuate. Labyrinthitis Sudden severe vertigo with profound hearing loss and prolonged vertigo (i.e., >24 hours). Vertigo, nausea with hearing loss, not episodic, not fluctuating. Vestibular Neuritis Viral infection of vestibular system: Leads to acute, prolonged vertigo with prolonged nausea, vomiting without hearing loss, tinnitus, or aural fullness. Severe rotational vertigo lasts 12–36 hours with decreasing disequilibrium for the next four to five days. Vertigo, nausea without hearing loss.

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