Questionnaire/history: Onset? Vertigo (at least two spontaneous episodes lasting 20 minutes to 12 hours)? Fluctuating hearing? Tinnitus and/or perception of aural fullness in the affected ear? Past medical history? Current medication? Drug allergies? Examination: Unable to stand with feet together and eyes closed (Romberg's test) or walk heel to toe in a straight line? If marches on the spot with eyes closed, unable to maintain position and turning to the affected side (Unterberger's test)? During an episode of vertigo, unidirectional, horizontal-torsional nystagmus (may be seen)? Investigation: Audiometry: Sensorineural hearing loss, low-to-mid frequency, on one or more occasions before, during, or after an episode of vertigo? Management: Hospital admission for IV labyrinthine sedatives and fluids if symptoms are severe Advised: - Acute attack will normally settle within 24 hours in most people - Reassured that vertigo usually significantly improves with treatment - To keep medication readily accessible - To consider the risks before undertaking activities such as operating dangerous machinery, using ladders or scaffolding, or going swimming - Not to drive when feeling dizzy - To seek medical advice if symptoms deteriorate or no improvement after 5–7 days - To contact own GP to be referred to ENT to confirm diagnosis and if hearing loss for an audiology assessment, if not already carried out by ENT services Buccal prochlorperazine or IM prochlorperazine or cyclizine to rapidly relieve (severe) nausea or vomiting Buccal prochlorperazine for 7 (or 14 days if required previously) or antihistamine (eg cinnarizine, cyclizine, or promethazine teoclate) Recurrent attacks of Meniere's disease: Betahistine to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo If not beneficial, referral to ENT Reference(s): NICE CKS: Ménière's disease Information for patient/carer(s): NHS Health A to Z: Ménière's disease