Peripheral Causes of Vertigo

Aka: Peripheral Causes of Vertigo, Vertigo due to Peripheral Causes, Tullio's Phenomenon, Acute Peripheral Vestibulopathy

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II. Findings: Suggestive of peripheral causes

  1. Pathognomonic for peripheral cause
    1. Sudden onset with brief episodes often on awakening
    2. Rotary Illusion with Nausea, Vomiting
  2. Nystagmus
    1. Combined horizontal and torsional Nystagmus
    2. Persists 5-20 seconds after Dix-Hallpike Maneuver
    3. Fixation of eyes on object inhibits Nystagmus
  3. Moderate imbalance
  4. Nausea or Vomiting
  5. Associated findings
    1. Hearing Loss
    2. Tinnitus
  6. Tullio's Phenomenon
    1. Nystagmus and Vertigo provoked by loud sounds

III. Causes: Common (Peripheral Vertigo)

  1. Acute Vestibular Neuronitis
  2. Benign Paroxysmal Positional Vertigo
  3. Meniere's Disease

IV. Causes: Other (Peripheral Vertigo)

  1. Ear Infections
    1. Serous Otitis Media
    2. Chronic Otitis Media
    3. Otitis Externa
    4. Mastoiditis
  2. Other infections
    1. Herpes Zoster Oticus (Ramsay Hunt Syndrome)
    2. Acute Labyrinthitis (uncommon)
      1. Not synonymous with Vestibular Neuronitis
        1. Labyrinthitis is much less common than Neuronitis
        2. Labyrinthitis causes permanent Hearing Loss
      2. Types
        1. Viral Labyrinthitis
        2. Bacterial Labyrinthitis (Rare)
  3. Structural disorder
    1. Cholesteatoma
    2. Perilymphatic Fistula
    3. Otosclerosis
  4. Trauma
    1. Temporal Bone Fracture
    2. Labyrinthine Concussion

V. References

  1. Baloh (1999) Postgrad Med 105(2):161-72 [PubMed]
  2. Knox (1997) Am Fam Physician 55(4):1185-90 [PubMed]
  3. Labuguen (2006) Am Fam Physician 73:244-51 [PubMed]
  4. Tusa (2005) Neurol Clin 23:655-673 [PubMed]
  5. Tusa (2003) Med Clin N Am 87:609-41 [PubMed]

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