Making a diagnosis in patients who present with vertigo

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5809 (Published 03 September 2012) Cite this as: BMJ 2012;345:e5809
  1. D Kaski, neurology registrar,
  2. A M Bronstein, professor of neuro-otology
  1. 1Department of Neuro-otology, Charing Cross Hospital, Imperial College London, London W6 8RF, UK
  1. d.kaski{at}imperial.ac.uk

Not all vertigo is labyrinthitis

Dizziness is a common problem. For many non-specialists the term “vertigo” has become synonymous with labyrinthitis, a label that is often attached to acute and chronic dizziness that is presumed to be benign in origin. However, vertigo is simply the illusion of movement, whereas labyrinthitis refers to inflammation of the labyrinth (vestibular and cochlear parts) and is exceptionally rare in clinical practice. Furthermore, vestibular neuritis—inflammation of the vestibular nerve with sparing of the cochlear nerve, which is more common than labyrinthitis—is also often referred to as “vestibular labyrinthitis.” It is important that patients who present with dizziness are given the correct diagnosis both to avoid missing serious neurological causes and to ensure that the right treatment is given.

The incidence of vestibular neuritis is about 3.5 per 100 000 population,1 although it is probably overdiagnosed and often misdiagnosed. In a study of patients referred to a specialist neuro-otology service with vestibular neuritis mislabelled as labyrinthitis, the diagnosis was correct in only 15%; most of the others had benign paroxysmal positional vertigo (BPPV) or vestibular migraine.2 …

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