title: Vertigo with sudden hearing loss: audio-vestibular characteristics.
abstract: 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.
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia.|Central Clinical School, University of Sydney, Camperdown, 2050, NSW, Australia.|Department of Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent's Hospital, Darlinghurst, 2050, NSW, Australia.
authors.forename: Jacob M
authors.identifier: http://orcid.org/0000-0002-6523-6642
authors.initials: JM
authors.lastname: Pogson
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia.|Central Clinical School, University of Sydney, Camperdown, 2050, NSW, Australia.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Taylor
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Young
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: McGarvie
authors.affiliation: Department of Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent's Hospital, Darlinghurst, 2050, NSW, Australia.|Faculty of Medicine, University of NSW, Kensington, 2033, NSW, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Flanagan
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia.|Central Clinical School, University of Sydney, Camperdown, 2050, NSW, Australia.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Halmagyi
authors.affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Level 8 East 1, Camperdown, 2050, NSW, Australia. miriam@icn.usyd.edu.au.|Central Clinical School, University of Sydney, Camperdown, 2050, NSW, Australia. miriam@icn.usyd.edu.au.
authors.forename: Miriam S
authors.initials: MS
authors.lastname: Welgampola
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D001298:Audiology; D001299:Audiometry; D005072:Evoked Potentials, Auditory / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D064087:Head Impulse Test; D003639:Hearing Loss, Sudden / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009760:Nystagmus, Physiologic; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D014717:Vertigo / Q000150:complications* / Q000000981:diagnostic imaging
keywords: Ischemia; Labyrinthitis; Sudden sensorineural hearing loss; Vertigo; Vestibular neuritis