1. Unilateral peripheral vestibulopathies.
| Vestibulopathy | Incidence | Aetiology | Symptoms | Diagnosis | Treatment |
| Benign paroxysmal positional vertigo (BPPV) (idiopathic) (Cabrera Kang 2013; Hilton 2014) | All age groups Peak 40 to 60 years 11 to 64 per 100,000 pa Females > males |
Various: Canalithiasis (free‐floating debris in semicircular canals) Cupulolithiasis (debris attached to cupula) |
Episodic vertigo after rapid head motion, lasting seconds to 1 minute; +/‐ nausea; some balance deficits; nystagmus (latency, fatigue, rotatory and beating) | Dix‐Hallpike test (post) (Dix 1952) Lateral head‐trunk tilt (Brandt 1999) etc. Use of ENG to record nystagmus |
1. Repositioning manoeuvre/s relative to semicircular canal (Cabrera Kang 2013; Epley 1992; Semont 1988) 2. VR 3. Vestibular suppressant medication for symptom relief 4. Vestibular neurectomy or post‐semicircular canal obliteration |
| Vestibular neuritis (Gans 2002)/neuronitis and labyrinthitis (Strupp 1998) | Unknown | Unclear Viral, autoimmune or vascular mechanisms Viral or bacterial infection of labyrinthine fluids (labyrinthitis) or CN VIII (neuritis) |
Acute onset Distressing tonal imbalance producing: rotatory vertigo; spontaneous nystagmus (horizontal); falls to the affected side; nausea |
From history and presentation ENG and caloric irrigation show reduced or no response in horizontal semicircular canal; ocular tilt reaction |
Symptomatic medication (vestibular suppressants) Bacterial/viral management VR |
| Ménière's disease (Scott 1994; Strupp 2013) | Unknown Equal males and females Greatest in 3rd and 4th decades |
Unclear Endolymphatic hydrops |
Acute: unpredictable and episodic hearing loss, tinnitus and vertigo, +/‐ nausea, vomiting, visual disturbance, anxiety, motion sensitivity Chronic: UPVD or bilateral PVD |
History and presentation Audiogram ENG with calorics Imaging the inner ear with high‐resolution MRI after tympanic gadolinium injection |
Acute: medication (transtympanic glucocorticoids, antihistamines, suppressants)
diet; low salt; diuretics Chronic: VR, psychological support, surgery (see next row) |
| Postoperative:
Labyrinthectomy Neurectomy Intra‐tympanic injection of gentamycin |
Unknown | For management of intractable UPVD, tumour removal, Ménière's | UPVD, i.e. spontaneous nystagmus, vertigo, disequilibrium, VOR gain, postural instability | — | VR Symptomatic medication (Dowdal‐Osborn 2002) |
| Perilymphatic fistula (Baloh 2003) | Unknown | History of head trauma, barotraumas or sudden strain; may be associated with chronic otitis or cholesteatoma; perforation of tympanic membrane | Unilateral hearing loss, vertigo, nystagmus | Induce symptoms by pressure in external ear canal Positive head thrust ENG Audiography |
Symptomatic medication Surgical packing |
ENG: electronystagmography MRI: magnetic resonance imaging pa: per year UPVD: unilateral peripheral vestibular disorder VOR: vestibular ocular reflex VR: vestibular rehabilitation