An elderly patient enters your room appearing unsteady, ‘No, I haven’t had too much to drink, Doc!’. You probably already have a differential diagnosis in your head, labyrinthitis being one of them. But, as this BMJ editorial reminds us, not all vertigo is labyrinthitis (BMJ 2012; 345:e5809).
The authors stress that the terms vertigo and labyrinthitis are not synonymous. Vertigo simply refers to an illusion of movement, whereas labyrinthitis (or more correctly vestibular neuritis) is actually rare with an incidence of 3.5/100,000/y. In one study, only 15% of patients referred to neuro-otology service with vestibular neuritis had the diagnosis; most of the others had benign paroxysmal positional vertigo (BPPV) or vestibular migraine. So, how can we get the diagnosis right?