Last reviewed: September 2018
Last updated: October  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • medication history
  • 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
  • history of cerebrovascular disease
  • history of multiple sclerosis
  • history of head trauma
  • history of depression
  • history of anxiety

Diagnostic investigations

Investigations to consider

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

Emerging tests

  • otoacoustic emissions
  • functional MRI
  • PET scan
  • magnetoencephalographic
Full details

Treatment algorithm

Contributors

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

Celebration

FL

Disclosures

MDS is a consultant for Acclarent; is the owner of Body Language Vitamins; and is involved in post-market studies for Envoy (non-compensated) and research for MicroTransponder, Inc (non-compensated), Auris Medical, and the National Institutes of Health. He receives royalties from 7 patents. He is an author of a number of references cited in this topic.

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 topic. 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

MI

Consulting Staff

Toledo ENT

Toledo

OH

Disclosures

AB declares that he has no competing interests.

Consultant ENT Surgeon

Frimley Park Hospital

Portsmouth Road

Frimley

Surrey

UK

Disclosures

AM declares that he has no competing interests.

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