• AKA Vestibular Neuritis with hearing loss
  • Inflammatory disorder of the inner ear
  • Often viral inflammation of vestibular portion of CN VIII
  • Inflammation decreases afferent firing from the labyrinth
    • CNS interprets the decreased signal as head rotation away from the diseased labyrinth
    • The imbalance in firing from the labyrinth results in spontaneous nystagmus with fast phase away from the pathologic side
  • Benign, self-limited
  • Unilateral vestibular dysfunction
  • Causes balance disorders and vertigo, and may be associated with hearing loss and tinnitus
  • Peak onset 30–60 yr old
  • Associated with viral upper respiratory tract infection in 50% of patients
  • Symptoms predominantly with head movement but can persist at rest
  • Recovery phase gradual over weeks to months


  • 3 most common causes of peripheral vertigo include, benign paroxysmal positional vertigo (BPPV), Ménière disease, and labyrinthitis
  • Labyrinthitis:
    • Serous: Viral or bacterial
    • Suppurative: Bacterial
    • Autoimmune: Wegener's or polyarteritis nodosa
    • Vascular ischemia
    • Head injury or ear trauma
    • Medications:
      • Aminoglycosides, loop diuretics, antiepileptics (phenytoin)
    • Allergies
    • Chronic
  • BPPV:
    • Dislodgement of otoconia debris:
      • Idiopathic: 49%
      • Posttraumatic: 18%
      • Sequela of labyrinthitis: 15%
      • Sequela of ischemic insult

Pediatric Considerations
  • Suppurative and serous labyrinthitis:
    • Usually secondary to acute otitis media, mastoiditis, or meningitis
  • BPPV:
    • Onset 1–5 yr of age
    • Symptoms: Abrupt onset of crying, nystagmus, diaphoresis, emesis, ataxia
    • Recurrences for up to 3 yr
    • Migraine–BPPV complex is the most common etiology of pediatric vertigo
  • Ménière disease:
    • Rare before 10 yr of age

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