Vertigo with sudden hearing loss: audio-vestibular characteristics
- 861 Downloads
Acute vertigo with sudden sensorineural hearing loss (SSNHL) is a rare clinical emergency. Here, we report the audio-vestibular test profiles of 27 subjects who presented with these symptoms. The vestibular test battery consisted of a three-dimensional video head impulse test (vHIT) of semicircular canal function and recording ocular and cervical vestibular-evoked myogenic potentials (oVEMP, cVEMP) to test otolith dysfunction. Unlike vestibular neuritis, where the horizontal and anterior canals with utricular function are more frequently impaired, 74 % of subjects with vertigo and SSNHL demonstrated impairment of the posterior canal gain (0.45 ± 0.20). Only 41 % showed impairment of the horizontal canal gains (0.78 ± 0.27) and 30 % of the anterior canal gains (0.79 ± 0.26), while 38 % of oVEMPs [asymmetry ratio (AR) = 41.0 ± 41.3 %] and 33 % of cVEMPs (AR = 47.3 ± 41.2 %) were significantly asymmetrical. Twenty-three subjects were diagnosed with labyrinthitis/labyrinthine infarction in the absence of evidence for an underlying pathology. Four subjects had a definitive diagnosis [Ramsay Hunt Syndrome, vestibular schwannoma, anterior inferior cerebellar artery (AICA) infarction, and traction injury]. Ischemia involving the common-cochlear or vestibulo-cochlear branches of the labyrinthine artery could be the simplest explanation for vertigo with SSNHL. Audio-vestibular tests did not provide easy separation between ischaemic and non-ischaemic causes of vertigo with SSNHL.
KeywordsVertigo Sudden sensorineural hearing loss Vestibular neuritis Labyrinthitis Ischemia
This study was funded by the National Health and Medical Research Council of Australia. We wish to thank the vestibular nurses for assistance operating the Omniax rotator, Ms. Druvinka Bandaranayake for nystagmus analysis, and Dr. Andrew Brandshaw for LabView programming and the labyrinth image.
Compliance with ethical standards
Conflict of interest
GMH and LAM are unpaid consultants to GN Otometrics. The other authors have nothing to declare.
All subjects gave consent for the collection of results and participation. The study was approved by the Sydney Local Health District (RPAH Zone) ethics committee.
- 2.Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, Brown SR, Fife TD, Ford P, Ganiats TG, Hollingsworth DB, Lewandowski CA, Montano JJ, Saunders JE, Tucci DL, Valente M, Warren BE, Yaremchuk KL, Robertson PJ (2012) Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 146(3 Suppl):S1–S35. doi: 10.1177/0194599812436449
- 11.Akdal G, Michael Halmagyi G (2012) Sudden vertigo in a 49-year-old man. 19(12):1751. doi: 10.1016/j.jocn.2012.05.005
- 15.Merchant SN, Nadol JB (2010) Schuknecht’s Pathology of the Ear. People’s Medical Publishing House-USAGoogle Scholar
- 16.Hansen CC, Mazzoni A (1969) Vascular anatomy of the human temporal bone. Acta Oto-laryngologica Suppl 263:46–47Google Scholar
- 22.National Occupational Health and Safety Commission (2000) National standard for occupational noise, 2nd edn, Department of Communications, Information Technology and the Arts, Commonwealth of AustraliaGoogle Scholar
- 26.Jerger J (1970) Clinical experience with impedance audiometry. Archiv Otolaryngol (Chicago, Ill: 1960) 92 (4):311–324Google Scholar