All audiologists have an audiometer. So what can you do with an audiometer that might be of value to the dizzy patient? A comprehensive audiometric evaluation will not allow a firm diagnosis, but history combined with certain audiometric patterns can point you in the right direction.
A patient with a conductive hearing loss and flat tympanogram may be experiencing dysequilibrium as a result of middle ear effusion. In that case, referral to ENT for treatment of the effusion should be done before considering vestibular evaluation.
A patient with complaints of unilateral tinnitus and episodic vertigo may present with a low frequency unilateral sensorineural hearing loss. This pattern suggests the possibility of Meniere’s disease and vestibular evaluation is warranted.
A patient with progressive dysequilibrium (not vertigo), with a high frequency asymmetrical hearing loss, or unilateral decreased speech discrimination should be referred for retrocochlear studies, either ABR or cranial MRI, before considering vestibular testing.
A patient with fairly normal hearing, but increased sensitivity to bone conducted sounds (resulting in a difficult to explain conductive component) may be suffering from Superior Canal Dehiscence Syndrome.
A patient with acute severe vertigo and accompanying sudden onset sensorineural hearing loss may be suffering from acute Labyrinthitis. If the symptoms have been present for less than a few days, spontaneous nystagmus should be visible.
Each patient is a puzzle, and each test result is a piece of that puzzle that should guide you closer to, or further away from your initial suspected diagnosis.
