What are the key clinical features that differentiate labyrinthitis from vestibular neuronitis in a primary care setting?

Key clinical features differentiating labyrinthitis from vestibular neuronitis in primary care:

• Vestibular neuronitis typically presents with sudden onset of severe vertigo, nausea, vomiting, and gait unsteadiness without hearing loss or tinnitus. The vertigo usually lasts days, with gradual improvement over a week, although mild imbalance may persist for weeks. There are no auditory symptoms because the cochlear nerve is not involved ¹,².
• Labyrinthitis presents similarly with acute vertigo, nausea, and vomiting but is distinguished by the presence of hearing loss and/or tinnitus due to involvement of both the vestibular and cochlear components of the labyrinth ²,⁴.
• In labyrinthitis, hearing loss is a key differentiating feature and should prompt consideration of referral to ENT or audiovestibular services for further assessment ⁴.
• Both conditions may require symptomatic treatment and referral if symptoms persist beyond one week or if severe nausea and vomiting prevent oral intake ¹,².