Key Diagnostic Distinctions for Persistent Postural‑Perceptual Dizziness (PPPD)

Differentiation from Benign Paroxysmal Positional Vertigo (BPPV) and Ménière Disease

• The American Academy of Otolaryngology–Head and Neck Surgery reports that PPPD produces a persistent, continuous sensation of dizziness or unsteadiness that lasts for months, whereas BPPV generates brief, seconds‑to‑minutes episodes of vertigo triggered by specific head positions. 1, 2
• According to the same authority, hearing remains normal in PPPD, distinguishing it from Ménière disease, which is characteristically associated with fluctuating sensorineural hearing loss. 1

Clinical Red Flags Requiring Additional Evaluation

• The American Academy of Otolaryngology–Head and Neck Surgery advises that the presence of atypical features—such as new‑onset hearing loss, gait disturbances not explained by PPPD, vertigo that is not position‑dependent, or persistent nausea/vomiting—should prompt investigation for co‑existing vestibular or central nervous system pathology. 1, 2, 3