Last reviewed: 19 Sep 2021
Last updated: 18 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • vertigo
  • hearing loss
  • tinnitus
  • aural fullness
  • drop attacks

Other diagnostic factors

  • positive Romberg test
  • Fukuda stepping test
  • bilateral symptoms
  • nystagmus
  • tandem walk

Risk factors

  • recent viral infection
  • genetic predisposition
  • autoimmune disease

Diagnostic investigations

1st investigations to order

  • pure-tone air and bone conduction with masking
  • speech audiometry
  • tympanometry/immittance/stapedial reflex levels
  • otoacoustic emissions (OAE)

Investigations to consider

  • electrocochleography
  • electronystagmography
  • rotary chair test
  • vestibular-evoked myogenic potential (VEMP)
  • MRI of internal auditory canals
  • thyroid function tests
  • Lyme disease and syphilis serology
  • antinuclear antibody
  • antineutrophil cytoplasmic antibody
  • rheumatoid factor

Treatment algorithm

Contributors

Authors

Soha N. Ghossaini, MD, FACS
Soha N. Ghossaini

Otology-Neurotology

Ear Nose and Throat Associates of New York

New York

NY

Disclosures

SNG has received sponsorship for BONEBRIDGE surgical training by MED-EL 2019.

Acknowledgements

Dr Ghossaini would like to gratefully acknowledge Professor Maurice H. Miller, a previous contributor to this topic. MHM declared that he had no competing interests. Unfortunately we have since been made aware that Professor Miller has passed away.

Peer reviewers

Steven D. Rauch, MD

Associate Professor of Otology and Laryngology

Harvard Medical School

Boston

MA

Disclosures

SDR declares that he has no competing interests.

Christopher J. Linstrom, MD

Professor

Otolaryngology/Head and Neck Surgery

The New York Eye and Ear Infirmary

Surgeon Director

New York

NY

Disclosures

CJL declares that he has no competing interests.

Peter Rea, MA, BM BCh, FRCS(ORL-HNS)

Consultant ENT Surgeon

Leicester Royal Infirmary

Leicester

UK

Disclosures

PR declares that he has no competing interests.

Doris Eva Bamiou, MD, MSc, PhD

Clinical Senior Lecturer & Consultant in Audiovestibular Medicine

Ear Institute

University College London

London

UK

Disclosures

DEB declares that she has no competing interests.

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