Differentials
Meniere's disease
SIGNS / SYMPTOMS
Fluctuating hearing loss, low-pitch tinnitus, low-frequency hearing loss, repeated episodes of vertigo.
INVESTIGATIONS
Complete audiological evaluation.
Includes pure-tone air and bone conduction, speech audiometry, tympanometry, and otoacoustic emissions.
Typically reveals sensorineural hearing loss mainly in the low frequencies, although other configurations of hearing losses may be present.
Posterior fossa cerebrovascular accident
SIGNS / SYMPTOMS
Ataxia, negative Romberg's test, dysarthria, dysphagia, hoarseness, facial paralysis, facial numbness, contralateral lower extremity weakness.
INVESTIGATIONS
Audiogram reveals sensorineural hearing loss.
CT scan of the head may be inconclusive, but a normal CT scan does not rule out a stroke - particularly in the first few hours.
MRI of the head with diffusion-weighted imaging would most likely be abnormal.
Temporal bone fracture
SIGNS / SYMPTOMS
Recent head trauma.
INVESTIGATIONS
CT scan of head delineates extent of fracture.
Inner ear malformations
SIGNS / SYMPTOMS
Progressive hearing loss.
INVESTIGATIONS
MRI or CT scan of head reveals the malformation. Possible findings include atresia or malformation of ossicular chain, abnormal incus, or missing cura of the stapes.
Labyrinthine haemorrhage
SIGNS / SYMPTOMS
Similar presentation to labyrinthitis.
INVESTIGATIONS
MRI T1-weighted images without contrast will show intra-labyrinthine hyper-intensity.
Vestibular migraine
SIGNS / SYMPTOMS
Associated headache, photophobia, phonophobia, aura.
INVESTIGATIONS
Imaging is normal.
Calorics on electronystagmography may be elevated.
Use of this content is subject to our disclaimer