Audiometric Patterns in Vestibular Disease





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.





About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.