Use the timing of vertigo relative to cochlear symptoms to decide whether the syndrome is Meniere disease or something that needs structural imaging. The cerebellopontine angle deserves attention when hearing loss and vertigo coexist, because a tumor can mimic inner ear disease.

Meniere disease produces vertigo episodes that are closely time-locked with cochlear symptoms; Low-frequency hearing loss supports the diagnosis; A roaring tinnitus is a classic clue; Schwannoma is the most common cerebellopontine angle tumor; Diagnostic certainty should rest on the symptom pattern and exclusion of mimics