Differentiating Benign Paroxysmal Positional Vertigo (BPPV) From Vestibular Neuritis-Labyrinthitis

BENIGN PAROXYSMAL POSITIONAL VERTIGO

 • Age: More common in older adults

 • Hearing loss: None

 • Frequency of symptoms: Episodic (occurs with certain movements of the head)

 • Hallpike test: Positive usually on one side only with upbeat and torsional nystagmus and reproduction of vertigo symptoms

 • Head impulse test: Negative (Note: It is advised not to administer head impulse test in a patient with a clinical history consistent with BPPV.)

 • Epley maneuver: Highly effective

 • Recurrence: Frequent

VESTIBULAR NEURITIS/LABYRINTHITIS

 • Age: More common in younger patients

 • Hearing loss: None in vestibular neuritis; hearing loss in labyrinthitis

 • Frequency of symptoms: Constant

 • Hallpike test: Symptoms may be worsened in head-hanging position (Note: It is advised not to administer Hallpike test in a patient with a clinical history consistent with vestibular neuritis or labyrinthitis.)

 • Head impulse test: Positive (corrective saccade seen)

 • Epley maneuver: Ineffective

 • Recurrence: Rare (2 to 11%)



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