Synopsis
Recognise an episodic audiovestibular pattern, establish the role of audiometry and exclusion of alternatives, and plan realistic symptom control with hearing and balance support.
- Think of recurrent spontaneous vertigo with fluctuating unilateral auditory symptoms.
- Definite disease requires at least two attacks lasting twenty minutes to twelve hours.
- Document sensorineural hearing loss with audiometry rather than symptom description alone.
Key red flags
New facial weakness, double vision, dysarthria or limb incoordination during vertigo demands emergency neurological assessment.
Investigation priorities
Document the auditory component and establish a baseline for follow-up.
Management branches
Recurrent spontaneous vertigo is accompanied by fluctuating hearing, tinnitus or aural pressure.
- Arrange ENT or audiovestibular assessment with audiometry, describing duration, laterality and the relationship between vestibular and auditory symptoms.
- Exclude urgent neurological and sudden-hearing-loss presentations before placing the person on a routine diagnostic pathway.
Key medicines
Betahistine 16 mg tablets, product 7053Start 8–16 mg orally three times a day with or after food. The cited product permits a total maintenance dose of 24–48 mg daily in two or three divided doses, with a maximum of 48 mg daily. Agree a review after a therapeutic trial over weeks to months.
Prochlorperazine oral tablets for an acute attackStemetil 5 mg orally three times daily is the licensed starting regimen for vertigo. Use the shortest attack-related course and stop when symptoms settle; the RCGP toolkit describes short courses up to seven days, with reassessment if symptoms persist. Start lower in older adults.