The presentation most consistent with benign paroxysmal positional vertigo (BPPV) would be vertigo with head movement, a classic presentation being dizziness while rolling over in bed.
Benign paroxysmal positional vertigo (BPPV) is a common form of peripheral vertigo that results from a dislodged piece of otolith (called otoconia when dislodged) causing disturbances in the semicircular canals. The presentation of BPPV involves sudden episodic vertigo with head movements that lasts for seconds accompanied by nausea and vomiting. This is in contrast to viral labyrinthitis which is constant over a few days and Meniere's disease which can last minutes to an hour. On physical exam, one can see a horizontal nystagmus with specific head postures (Dix-Hallpike maneuver). Treatment involves repositioning exercises (Epley maneuver) as well as meclizine.
Post and Dickerson discuss the presentation of dizziness which can be sub-classified into 4 types: vertigo, disequilibrium, presyncope, or lightheadedness. The most common causes of vertigo include BPPV, Meniere's disease, vestibular neuritis, and labyrinthitis. Furthermore, the physical exam can help narrow the diagnosis using the Dix-Hallpike maneuver (to look for nystagmus), and orthostatic blood pressure testing. Treatments for vertigo involve the Epley maneuver (canalith repositioning) and vestibular rehabilitation for benign paroxysmal positional vertigo, intratympanic dexamethasone or gentamicin for Meniere disease, and steroids for vestibular neuritis.
Otsuka et al. analyze various treatments for BPPV. The response was determined by the canal in which the otolith was present. Posterior canal BPPV responded better to the Epley maneuver group compared to medication group. Lateral canal BPPV responded better to the Lempert maneuver compared to medication. Resolution time was significantly longer in the lateral canal cupulolithiasis patients than in the other patients. Of note, the higher the age of the patient, the greater the chance that BPPV was intractable.
Illustration A displays the vestibular system with otoconia inside.
Answer 1: Dizziness when standing still is most consistent with a viral labyrithitis.
Answer 3: Dizziness when straining on the toilet could be consistent with superior canal dehiscence syndrome.
Answer 4: Dizziness with hearing loss is most consistent with Meniere's disease.
Answer 5: Dizziness with severe headache is most consistent with a vestibular schwannoma.
Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010 Aug 15;82(4):361-8, 369.
PMID:20704166 (Link to Abstract)
Otsuka K, Ogawa Y, Inagaki T, Shimizu S, Konomi U, Kondo T, Suzuki M. Relationship between clinical features and therapeutic approach for benign paroxysmal positional vertigo outcomes. J Laryngol Otol. 2013 Oct;127(10):962-7.
PMID:24047965 (Link to Abstract)