Hearing loss and duration of symptoms help narrow the differential diagnosis further in patients with vertigo. Vertigo with hearing loss is usually caused by Meniere disease or labyrinthitis, whereas vertigo without hearing loss is more likely caused by BPPV or vestibular neuritis.8 Unilateral auditory symptoms help localize the cause to an anatomic abnormality, particularly in patients with peripheral disease.9 Episodic vertigo tends to be caused by BPPV or Meniere disease, whereas persistent vertigo can be caused by vestibular neuritis or labyrinthitis.8