Last reviewed: June 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • medication hx
  • episodic sounds
  • hearing loss
  • vertigo
  • pulsatile sounds
  • clicking sounds
  • visual changes
  • presence of bruits or hums
  • cranial nerve palsies
  • cerumen (ear wax)
  • abnormal otoscopy
  • abnormal Weber's test
  • abnormal Rinne's test

Other diagnostic factors

  • slow-onset progressive hearing loss
  • high pitch
  • low pitch
  • unilateral
  • bilateral
  • worse with chewing
  • polyuria/polydipsia
  • diarrhoea
  • palpitations
  • foreign body

Risk factors

  • older age
  • hearing loss
  • loud noise exposure
  • vestibular schwannoma
  • ototoxic medicines
  • heavy metal exposure
  • hx of cerebrovascular disease
  • hx of multiple sclerosis
  • hx of head trauma
  • hx of depression
  • hx of anxiety

Diagnostic investigations

Investigations to consider

  • FBC
  • thyroid function tests (TFT)
  • lipid profile
  • fasting glucose
  • MRI head
  • CT temporal bones
  • MR angiography (MRA)
  • carotid angiography
  • auditory brainstem response (ABR)
  • minimal masking level (MML)
  • residual inhibition
  • loudness and pitch matching
  • loudness discomfort level testing
Full details

Emerging tests

  • otoacoustic emissions
  • functional MRI
  • PET scan
  • magnetoencephalographic (MEG)
Full details

Treatment algorithm


Authors VIEW ALL

Medical Director Otologic/Neurotologic/Skull Base Surgery

Medical Director Wellness

Florida Hospital Celebration Health

Professort of Otolaryngology-Head and Neck Surgery

University of Central Florida

Board of Directors American Academy of Otolaryngology-Head and Neck Surgery




MDS has received funding from the NIH and Auris Medical; he receives royalties from ViSalus Sciences for his roles as Chief Scientific Officer and Director of the Medical Advisory Board; he is the founder of Body Language Vitamins Co.; he has assisted in non-compensated work for Envoy Medical, Auris Medical, and Microtransponder, Inc.; he has 7 patents; and he is part of the leadership on the AAO-HNS Board of Directors. He is an author of a number of references cited in this monograph.

Dr Michael D. Seidman would like to gratefully acknowledge Dr Hamid Djalilian, Dr Alice Lee, Dr Vanessa Rothholtz, and Dr Sanaz Hamidi, the previous contributors to this monograph. HD, AL, VR, and SH declare that they have no competing interests.

Peer reviewers VIEW ALL

Clinical Adjunct Professor

Division of Neurotology

Department of Otolaryngology Head and Neck Surgery

University of Michigan

Ann Arbor


Consulting Staff

Toledo ENT




AB declares that he has no competing interests.

Consultant ENT Surgeon

Frimley Park Hospital

Portsmouth Road





AM declares that he has no competing interests.

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