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 weeks, and no auditory symptoms are present 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 the cochlear nerve alongside the vestibular nerve 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 referral if symptoms persist beyond one week or if severe nausea and vomiting prevent oral intake ¹,².