BPPV vs Meniere disease
How to tell BPPV and Meniere disease apart when a board question makes them look alike.
BPPV: seconds of position-triggered vertigo with normal hearing; Meniere: episodic vertigo with hearing loss, tinnitus, and aural fullness.
Side by side
Brief vertigo triggered by head position changes without hearing loss.
Recurrent vertigo with fluctuating hearing loss, tinnitus, and aural fullness.
Dislodged otoconia stimulate semicircular canals during specific head movements.
Endolymphatic hydrops distends the inner ear.
BPPV: Dix-Hallpike maneuver provokes a brief torsional/upbeat nystagmus with latency (a few seconds), fatigability on repeated testing, and reproducibility. Audiometry is normal. The Epley canalith repositioning maneuver is both diagnostic confirmation and treatment.
Meniere: audiometry during episodes shows low-frequency sensorineural hearing loss that may fluctuate, with documented endolymphatic hydrops on delayed-gadolinium MRI in established cases. Caloric testing often shows reduced vestibular response on the affected side.
The trap
Both cause vertigo; vestibular neuritis is the third trap with days-long postviral vertigo and no hearing loss.
Watch it explained
The repair move
For every vertigo stem, write down three things before naming the disease: duration of a single spell (seconds, minutes-to-hours, days), trigger (head position, spontaneous, post-viral), and hearing symptoms (none, low-frequency loss, tinnitus). BPPV is seconds-positional-no-hearing. Meniere is hours-spontaneous-with-hearing. Vestibular neuritis is days-spontaneous-no-hearing. Labyrinthitis is vestibular neuritis plus hearing loss.
Try a free question
CoreA patient has brief episodes of vertigo lasting less than a minute when rolling over in bed. There is no hearing loss or tinnitus. Which diagnosis is most likely?
Show answer and explanation
Answer: A. BPPV. Brief positional vertigo without hearing symptoms points to BPPV.
Why the other choices are tempting
- B. Meniere disease causes recurrent vertigo with hearing loss, tinnitus, and aural fullness.
- C. Vestibular neuritis causes continuous days-long vertigo after viral illness without hearing loss.
- D. Acoustic neuroma causes progressive unilateral hearing loss and imbalance.
- E. Labyrinthitis causes vertigo with hearing symptoms after infection.
Flashcards
Tap a card to flip it.
What is the fastest separator for BPPV vs Meniere disease?
BPPV: seconds of position-triggered vertigo with normal hearing; Meniere: episodic vertigo with hearing loss, tinnitus, and aural fullness.
What clue should make you choose BPPV?
Brief vertigo triggered by head position changes without hearing loss.
Quick answers
What is the fastest way to tell BPPV from Meniere disease?
BPPV: seconds of position-triggered vertigo with normal hearing; Meniere: episodic vertigo with hearing loss, tinnitus, and aural fullness.
What is the key clue for BPPV?
Brief vertigo triggered by head position changes without hearing loss.
What is the key clue for Meniere disease?
Recurrent vertigo with fluctuating hearing loss, tinnitus, and aural fullness.
What is the common trap with BPPV vs Meniere disease?
Both cause vertigo; vestibular neuritis is the third trap with days-long postviral vertigo and no hearing loss.