What is the difference between bppv and labyrinthitis

Jump to content. Labyrinthitis say "lab-uh-rin-THY-tus" is a problem inside the inner ear. It happens when the labyrinth, a part of the inner ear that helps control your balance, gets swollen and inflamed.

Vestibular neuritis is an inflammation of the vestibular nerve. The nerve is located in the inner ear. It carries signals that help with your balance from the inner ear to the brain.

The inflammation of either condition may cause sudden vertigo. This makes you feel like you're spinning or whirling. Labyrinthitis may also cause temporary hearing loss or a ringing sound in your ears. The two problems have similar symptoms and treatment. However, if you have both sudden vertigo and hearing loss, you need urgent care to rule out a stroke. See pictures of the inner ear showing the labyrinth and an inflamed vestibular nerve. The causes of labyrinthitis and vestibular neuritis are not clear.

They can happen after a viral infection or, more rarely, after an infection caused by bacteria. The trigger may be an upper respiratory infection , such as the flu or a cold. Less often, it may start after a middle ear infection. The infection inflames the vestibular nerve.

This causes the nerve to send incorrect signals to the brain that the body is moving. But your other senses such as vision don't detect the same movement. There is a fairly well recognized situation where there is vestibular neuritis on one side, and then after a fairly long gap usually years , on the other as well, leaving the person with both ears damaged. This was first described by Schuknecht and Witt in , and called "bilateral sequential vestibular neuritis".

Here the diagnosis can be reasonably well established by observing two typical bouts of VN, but ending up with bilateral loss rather than recovery. As vestibular neuritis tends to spare the inferior vestibular nerve Goebel et al, , one might expect these patients to have present "cVEMP" tests, but absent calorics and rotatory chair responses.

The VHIT test provides another way to document this -- absent superior vestibular nerve responses i. Posterior canal. These situations are very unusual and the VHIT test is not very reliable either, when considering the vertical canals.

The situation where both ears are "taken out" at the same time, also seems plausible, but difficult to prove. One would think that this would result in an "idiopathic" bilateral loss presentation. There are indeed a very substantial number of "idiopathic" bilateral vestibular loss. However, as the causal diagnosis presumably would require an autopsy, it does not seem likely that we will clear this up anytime soon.

This is a "medical hypothesis". One would expect that those with preserved portions of their vestibular system would do better, long term, than those with a total "wipe out". So there is some rehab implication. When there is clear evidence of vestibular nerve damage, it is still simply called "recurrent vestibular neuritis. When it is recurrent, but there is normal vestibular function, the same symptom complex may generate other potential diagnoses.

For situations where there is dizziness but lacking strong evidence of vestibular nerve damage i. More simply, these can all be boiled down into a catch-all of migraine associated vertigo. As is the usual case for almost anything having "migraine" in it's name, nearly anything goes, because migraine is a "wastebasket syndrome " that has no specific objective findings. One does not even have to have a headache. It may be familial for example Oh et al, Rather than lumping BRV into migraine, it may instead be an entity by itself Lee et al, but lacking any clear diagnostic findings that distinguish it from recurrent vestibular neuritis or acephalgic migraine.

So in essence, this is a symptom complex without a clear evidence base establishing mechanism. When labyrinthitis recurs i. The reason for this is that the diagnostic criteria for Meniere's are essentially those of recurrent labyrinthitis. It is the author's impression that this "conversion" process occurs far more commonly than there is recurrent vestibular neuritis. Another recurrence pattern in vestibular neuritis is the "quick spin" pattern - -people complain of brief spells lasting seconds to minutes in which the entire world rotates at high speed, then stops, without any hearing symptoms.

This pattern of dizziness often responds to anticonvulsants such as carbamazepine or oxcarbamazine, and in these situations, may reasonably be attributed to vestibular paroxysmia. In this disorder, one can often recognize the patient the video-frenzel goggles. There is a paretic type spontaneous nystagmus and vibration induced nystagmus , which reverses with hyperventilation for 30 seconds.

Case example of quick spins : A middle aged administrator complained of multiple spells of spinning vertigo with nausea unaccompanied by hearing symptoms. The spells lasted minutes, were accompanied by sweating and nausea. He has had times in which he has had three or four episodes per day. There appear to be no consistent triggers. On examination, a right-beating spontaneous nystagmus was observed.

This reversed direction with hyperventilation. For the most common type of unilateral vestibular neuritis, you will probably be unable to work for one or two weeks. You may be left with some minor sensitivity to head motion which will persist for several years, and may reduce your ability to perform athletic activities such as racquetball, volleyball and similar activities.

After the acute phase is over, for a moderate deficit, falls are no more likely than in persons of your age without vestibular deficit Herdman et al, Persons in certain occupations, such as pilots, may have a greater long term impact Shupak et al, This may sound obvious, but oddly enough not everyone agrees about this, but the duration of your symptoms depends on the severity of damage.

If you have a "unilateral wipe out", nothing left, you will not do as well as someone with a mild unilateral vestibular weakness. Other important variables are how hard you "push" yourself to recover it is better to push , and how anxious you get about this condition. Unfortunately, sometimes the health care system ends up focusing attention on illness rather than wellness.

In other words, it is usually best to push to recover a normal life, and not make caring for your vestibular neuritis your "new career". This may mean saying "no Thank you" to some well-meaning health care providers, who want to be your personal trainer for vestibular issues. You may also have mild problems with your thinking. Even in persons who are well compensated, sensory integration seems to require more attention in persons with vestibular lesions than normal subjects Redfern et al, Acknowledgment : The graphic of figure 1 was originally funded by NIH.

Distinguishing and treating causes of central vertigo. Otolaryngol Clin North Am. Symptoms of vertigo in general practice: a prospective study of diagnosis. Drozd CE. Acute vertigo: peripheral versus central etiology. Nurse Pract. Baloh RW. The dizzy patient. Postgrad Med. Evaluating dizziness. Am J Med. Evans JG. Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness. Age Ageing. Rosenberg ML, Gizzi M.

Neurootologic history. The rational clinical examination. Does this dizzy patient have a serious form of vertigo? Differentiating between peripheral and central causes of vertigo.

Otolaryngol Head Neck Surg. Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol. Berkowitz BW. Matutinal vertigo. Clinical characteristics and possible management.

Arch Neurol. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. Kentala E, Rauch SD. A practical assessment algorithm for diagnosis of dizziness. Drachman DA. A year-old man with chronic dizziness [published correction appears in JAMA ;]. Saeed SR. Fortnightly review. Migraine-related vestibulopathy. Ann Otol Rhinol Laryngol. A directed approach to the dizzy patient.

Ann Emerg Med. Arch Otolaryngol Head Neck Surg. Acta Neurol Scand. Isolated acute vertigo in the elderly; vestibular or vascular disease?. Vertigo and hearing loss. The diagnostic value of imaging the patient with dizziness. A Bayesian approach. Coordinator of the series is Ricardo G. Hahn, M. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Jan 15, Issue. Initial Evaluation of Vertigo. C 7 , 10 The Dix-Hallpike maneuver has a positive predictive value of 83 percent and negative predictive value of 52 percent for the diagnosis of BPPV.

These episodes can bring about severe nausea and vomiting until they subside. Many patients with BPPV get relief from physical treatments, such as the Epley maneuver , which involves moving the head in a specific series of positions in an attempt to force the dislodged crystals out of the semicircular canals.

They may also be given anitbiotics or steroids to treat inflammation, as well as anti-vertigo drugs and diuretics. If you suffer from vertigo or dizziness, your best course of action is to visit your primary care physician and ask for a referral to an ear, nose and throat specialist ENT.

You may also need mental health help, as dealing with a balance disorder or dizziness is known to cause anxiety. Joy Victory has extensive experience editing consumer health information.

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