Neuro-otologic Emergencies: A Practical Approach

  • Kiersten L. GurleyEmail author
  • Jonathan A. Edlow


Neuro-otologic symptoms have an extensive differential diagnosis, including both benign and serious conditions across multiple organ systems. Distinguishing between common self-limiting conditions from serious conditions that require emergency treatment is paramount. This chapter focuses on differentiating benign peripheral vestibulopathies from dangerous cerebrovascular problems and sudden sensorineural hearing loss. Currently, misdiagnoses are frequent and diagnostic testing costs are high. We recommend an approach to the dizzy patient that emphasizes the value of history and a focused physical examination. It divides patients into three “timing and triggers” categories, each with its unique differential diagnosis and targeted diagnostic protocol: (1) acute vestibular syndrome, where “HINTS” eye movement tests, examination of cerebellar and brainstem functions, and gait assessments are used to differentiate vestibular neuritis from stroke; (2) spontaneous episodic vestibular syndrome, where associated symptoms may help differentiate vestibular migraine from transient ischemic attack; and (3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll positional tests help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. In addition, a practical approach to patients with sudden sensorineural hearing loss will be presented.


Dizziness Vertigo Stroke Sudden sensorineural hearing loss Vestibular diseases Physical examination Meniere’s Medical history taking Management Vestibular disorder Nystagmus Head impulse test Cerebellum Brainstem BPPV 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency MedicineBeth Israel Deaconess Medical Center/Harvard University School of MedicineBostonUSA
  2. 2.Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA

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