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.
