Benign positional vertigo also known as benign paroxysmal positional vertigo (BPPV) and Meniere’s
disease are similar in that they both are diseases that cause vertigo that is caused by an inner ear
disturbance. Vertigo is a feeling of spinning or whirling when you are still, it can be from a peripheral
origin or a central origin (Schroeder, K.,2018). Both BPPV and Meniere’s are from a peripheral etiology
so there is an absence of brainstem systems (Goroll & Mulley, 2014). Vertigo is a frequent complaint
that is encountered by the primary provider.
The presentation of a person who is experiencing BPPV will complain of vertigo that is associated with a
change in position and often they will report that their symptoms came on suddenly. The vertigo can
last a few seconds up to a minute, they can complain of a loss of balance, or they may have slight nausea
or vomiting. They may report that their symptoms are worse when they turn their head, lie back
quickly, turn over in bed, look upward, or if they bend over (Kellicker, P., 2018). The presentation of a
person who presents with Meniere’s is slightly different. They will complain of vertigo and it does not
depend on position, the episodes can last 20 minutes up to 3 hours, the vertigo can be accompanied by
nausea, vomiting, sweating, fluctuating hearing loss, ringing in the ears, and complaints of a fullness or
pressure in the ear, this is a chronic condition (Alan, R., 2018).
BPPV is more common in women that are in their second half of their life span (Kellicker, P., 2018),
versus Meniere’s tends to be more common in Caucasians that are 30-60 years old (Alan, R., 2018).
BPPV pathophysiology is from calcium carbonate particles known as otoconia that are inappropriately
displaced into the semicircular canals of the vestibular labyrinth of the inner ear, the otoconia are
microscopic crystals of calcium carbonate (Mayo Clinic, n.d.). The pathophysiology of Meniere’s is an
idiopathic endolymphatic hydrops with damage to the hair cells caused by swelling of the semicircular
ducts, there is too much fluid in the inner ear, and it becomes distended (Goroll & Mulley, 2014).
Risk factors for BPPV are being at an increased age (Kellicker, P., 2018). The risk factors for Meniere’s is
if there is a family history, having a viral infection or an autoimmune disorder, if there is a barometric
pressure change, increased stress, hormonal disorders, allergies, and excess salt in the diet (Alan, R.,
2018).
The assessment findings, diagnostic testing, and diagnosis for these two disorders will differ. When
doing an assessment to determine if the patient has BPPV the provider will want to do Dix-Hallpike
maneuver, as a diagnostic testing tool. This is done with the patient sitting with their head turned to
one side the patient is then placed supine quickly and observed for nystagmus for thirty seconds, if
there is no nystagmus then the patient is placed in a sitting position again and then observed for another
thirty seconds (Bhattacharyya, Gubbels, & Schwartz, 2017). This maneuver should be done on both
sides, nystagmus is provoked when the affected ear is turned downward when doing this maneuver,
however, a person can have symptoms of BPPV and still not have nystagmus. The testing for Meniere’s
is slightly different. There will be a hearing test done and the findings will show a low-to-medium
frequency sensorineural hearing loss in one ear and the patient will have had two or more spontaneous
episodes of vertigo that each last at least 20 minutes (Lopez-Escamez, J., Carey, J., Chung, W., Goebel, J.,
Magnusson, M., Mandala, M., Newman-Toker, D., Strupp, M., Suzuki, M., Trabalzini, F., Bisdorff, A.,
2015). The one thing that is the same and the most important in diagnosing either disease and cannot
be overlooked is to do a thorough history and exam of the patient. The provider needs to ask about
when this occurred, how long it lasted, if there were any triggers that make it worse. The physical exam
findings can then help to confirm the diagnosis.
disease are similar in that they both are diseases that cause vertigo that is caused by an inner ear
disturbance. Vertigo is a feeling of spinning or whirling when you are still, it can be from a peripheral
origin or a central origin (Schroeder, K.,2018). Both BPPV and Meniere’s are from a peripheral etiology
so there is an absence of brainstem systems (Goroll & Mulley, 2014). Vertigo is a frequent complaint
that is encountered by the primary provider.
The presentation of a person who is experiencing BPPV will complain of vertigo that is associated with a
change in position and often they will report that their symptoms came on suddenly. The vertigo can
last a few seconds up to a minute, they can complain of a loss of balance, or they may have slight nausea
or vomiting. They may report that their symptoms are worse when they turn their head, lie back
quickly, turn over in bed, look upward, or if they bend over (Kellicker, P., 2018). The presentation of a
person who presents with Meniere’s is slightly different. They will complain of vertigo and it does not
depend on position, the episodes can last 20 minutes up to 3 hours, the vertigo can be accompanied by
nausea, vomiting, sweating, fluctuating hearing loss, ringing in the ears, and complaints of a fullness or
pressure in the ear, this is a chronic condition (Alan, R., 2018).
BPPV is more common in women that are in their second half of their life span (Kellicker, P., 2018),
versus Meniere’s tends to be more common in Caucasians that are 30-60 years old (Alan, R., 2018).
BPPV pathophysiology is from calcium carbonate particles known as otoconia that are inappropriately
displaced into the semicircular canals of the vestibular labyrinth of the inner ear, the otoconia are
microscopic crystals of calcium carbonate (Mayo Clinic, n.d.). The pathophysiology of Meniere’s is an
idiopathic endolymphatic hydrops with damage to the hair cells caused by swelling of the semicircular
ducts, there is too much fluid in the inner ear, and it becomes distended (Goroll & Mulley, 2014).
Risk factors for BPPV are being at an increased age (Kellicker, P., 2018). The risk factors for Meniere’s is
if there is a family history, having a viral infection or an autoimmune disorder, if there is a barometric
pressure change, increased stress, hormonal disorders, allergies, and excess salt in the diet (Alan, R.,
2018).
The assessment findings, diagnostic testing, and diagnosis for these two disorders will differ. When
doing an assessment to determine if the patient has BPPV the provider will want to do Dix-Hallpike
maneuver, as a diagnostic testing tool. This is done with the patient sitting with their head turned to
one side the patient is then placed supine quickly and observed for nystagmus for thirty seconds, if
there is no nystagmus then the patient is placed in a sitting position again and then observed for another
thirty seconds (Bhattacharyya, Gubbels, & Schwartz, 2017). This maneuver should be done on both
sides, nystagmus is provoked when the affected ear is turned downward when doing this maneuver,
however, a person can have symptoms of BPPV and still not have nystagmus. The testing for Meniere’s
is slightly different. There will be a hearing test done and the findings will show a low-to-medium
frequency sensorineural hearing loss in one ear and the patient will have had two or more spontaneous
episodes of vertigo that each last at least 20 minutes (Lopez-Escamez, J., Carey, J., Chung, W., Goebel, J.,
Magnusson, M., Mandala, M., Newman-Toker, D., Strupp, M., Suzuki, M., Trabalzini, F., Bisdorff, A.,
2015). The one thing that is the same and the most important in diagnosing either disease and cannot
be overlooked is to do a thorough history and exam of the patient. The provider needs to ask about
when this occurred, how long it lasted, if there were any triggers that make it worse. The physical exam
findings can then help to confirm the diagnosis.
