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Viral Labrinthitis - constant Sx, short Hx
Meniere - hearing loss and tinnitus as well, episodes last longer

cerebellar - past pointing, dysdiadochokinesis
ears - fullness (meniere) BPPV, look at drums
sinuses - leaning forwards
pulsatile tinnitus - heart disease

commonest causes of vertigo - BPPV
Sudden onset dizziness and vertigo triggered by change in head position
average age onset 55yr

''Features''
vertigo triggered by change in head position - rolling over in bed, gazing upwards
may be associated with nausea
lasts 10-20 seconds
positive Dix-Hallpike manoeuvre

Good prognosis - resolves spontaneously in weeks to months
Sx relief via
Epley manoeuvre (80% success)
excersizes pt can do at home eg Brandt-Daroff
Medication (Betahistine) - limited value

''Hallpike'' .... each stage for 30secs, when lying head needs to go below level of bed
sit  ... lie back quickly and turn head to unaffected side (look for nystagmus and Sx occuring)
sit  ... lie back quickly and turn head to affected side

''Epley''
as for Hallpike but ... again each stage for 30 secs
sit ... lie and go to affected side .... then over to unaffected .... then roll to face downwards ... then sit up with chin on chest
quiet for rest of day