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Several prognostic indicators of favorable outcome in idiopathic sudden sensorineural hearing loss (ISSHL) have been proposed: an initial profound hearing loss, a downsloping audiometric curve, advanced age, and the presence of vertigo.
There is no agreement about the signs and symptoms that might predict a favorable prognosis in idiopathic sudden sensorineural hearing loss (ISSHL). Our study included 67 patients (37 male and 30 female) admitted to the department of otolaryngology of the Bnai-Zion Medical Center in Haifa between 1990 and 1997 owing to unilateral ISSHL. The correlation between high-tone ISSHL and poor prognosis was presented in a study by Linssen and Schultz-Coulon [4].
No matter the cause, the feelings of light-headedness, the sensation of vertigo or a loss of balance is concerning and can be disorienting. By noting the different conditions that trigger dizziness, we can start to understand your needs and the specific cause of dizziness.
OTITIS MEDIA Otitis media (OM) may be defined as inflammation of the middle ear due to any cause.
OTITIS MEDIA -- DIAGNOSIS Children with acute otitis media frequently present with sudden onset of fever, ear pain, and fussiness. OTITIS MEDIA -- COMPLICATIONS Complications of acute otitis media were common in the pre- antibiotic era. HEARING LOSS Conductive hearing loss Cerumen impactions Swelling of the external auditory canal Tympanic membrane perforation Middle ear fluid Ossicular chain abnormalities Sensorineural hearing loss Injury to hair cells in the cochlea or neural elements innervating the hair cells. HEARING LOSS -- AUDIOMETRY Hearing threshold levels are determined between 250 and 8000 Hertz (Hz) for pure tones and measured in decibels (dB). HEARING LOSS -- AUDIOMETRY A conductive hearing loss in the left ear due to otitis media with effusion.
HEARING LOSS -- AUDIOMETRY This audiogram suggests noise exposure that may be encountered occasionally in younger individuals who have been exposed to hazardous or “toxic” noise. HEARING LOSS -- TYMPANOGRAM Tympanometry is commonly used to evaluate the tympanic membrane (TM) and middle ear status. Three tympanograms demonstrating change in compliance of the middle ear (vertical axis) with changes in ear canal pressure.
OTITIS EXTERNA Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both This condition can be found in all age groups.
OTITIS EXTERNA -- CONSIDERATIONS Ramsay Hunt syndrome, more accurately known as herpes zoster oticus, is caused by varicella-zoster virus (VZV) infection. OTITIS EXTERNA -- TREATMENT Commonly used topical eardrops are acetic acid drops (which decrease pH), antibacterial drops, and antifungal preparations. DIZZINESS Patients frequently present with a complaint of “dizziness,” including symptoms such as disequilibrium, syncope, lightheadedness, ataxia, and vertigo. DIZZINESS – VESTIBULAR TESTING Vestibular testing can be performed to help determine whether the problem exists within the vestibular (balance) portion of the inner ear. DIZZINESS – VESTIBULAR TESTING There are four main parts to ENG testing Calibration test, which measures rapid eye movements Tracking test, which evaluates the ability of the eyes to track a moving target Positional test, which measures responses due to head movements Caloric test, which measures responses to warm and cold water introduced to the ear canal.
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) One of the most common causes of vertigo is benign paroxysmal positional vertigo (BPPV).
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) BPPV can usually be successfully treated with a canolith reposition maneuver (Epley or Semont maneuver) in the office setting. Bedside maneuver for the treatment of a patient with benign paroxysmal positional vertigo (BPPV) affecting the right posterior semicircular canal.
LABRYNTHITIS -- TREATMENT Treatment is symptomatic Vestibular suppressant medications (meclizine) Antiemetics Short, tapering course of oral steroids It may take several weeks for symptoms to completely resolve Residual vestibulopathy that persists for months or even years is not uncommon, and is best managed with vestibular rehabilitation. It is believed that an initial profound hearing loss, a sloping hearing curve, vertigo accompanying the hearing loss, and advanced age predict an unfavorable prognosis [1]. The possible prognostic factors in ISSHL evaluated using multivariate analysis included age, gender, vertigo, electronystagmography results, time elapsed between onset of sudden deafness and beginning of treatment, mean speech frequency threshold on admission, and a word recognition test. No significant prognostic relationship was found with improvement of audiometric threshold over the speech frequencies. The correlation between vertigo and high-tone hearing loss is explained by the anatomical proximity of the basal coil of the cochlea and the vestibule.
In our study, vertigo was found in 17 patients (27%), and we did not find any correlation between the presence of vertigo and the improvement of hearing at the various speech frequencies. Dizziness is a frustrating, yet typically short-lived condition, that generally results from a rapid or temporary change in the balance structures of the inner ear, also known as the vestibular system. This is the most common cause of vertigo and results when you change head position quickly. The most obvious sign of inner-ear inflammation is the sudden appearance of intense vertigo that lasts for a few days. Though not common, Meniere’s disease is also related to the inner ear and is triggered by excessive amounts of fluid in the ear. Due to: persistent noise exposure, age-related (presbycusis), genetic factors, and infectious or postinflammatory processes.
The 0-dB level is “normalized” to young, healthy adults and doesn’t mean there is absence of detectable sound.


Note that bone conduction thresholds are normal in both ears, but air conduction on the left is 30 dB poorer than that measured on the right.
Note that low-tone thresholds are relatively normal, with a drop in thresholds at higher frequencies.
This test assesses the mobility of the TM and its response to pressure changes in the external auditory canal.
Type A is normal, with the greatest compliance at the point where the pressure in the ear canal is equal to that of atmospheric pressure (peak is at 0). If the condition does not respond to treatment as expected, an otolaryngologist should evaluate the patient. It is characterized by facial nerve paralysis and sensorineural hearing loss, with bullous myringitis and a vesicular eruption of the concha of the pinna and the external auditory canal (EAC). True vertigo (an illusion of motion) is primarily associated with the balance organs of the inner ear.
BPPV is caused by sediment, such as calcium carbonate crystals, that have become free floating within the inner ear.
Dislodged otoliths repositioned into the vestibule is about 80 percent effective in eliminating symptoms of BPPV. The presumed position of the debris within the labyrinth during the maneuver is shown in panels A–D. It is thought to be caused by inflammation, secondary to a viral infection, of the vestibular portion of the eighth cranial nerve or of the inner ear balance organs (vestibular labyrinth). Vertigo accompanies ISSHL in 30-40% of cases and is considered to be a poor prognostic sign [1,2].
All patients underwent a complete audiological investigation, auditory brainstem response tests, electronystagmography, computed tomography of the brain and internal acoustic canals, and magnetic resonance imaging of the brain. Cochlear lesions may cause vestibular damage by endolymphatic alterations via ductus reuniens.
We did find a statistically significant correlation between vertigo and the lack of improved hearing at 8 kHz.
But realize the best way to truly understand your condition is by visiting a Utah dizziness doctor.
For some patients, the vertigo may be so strong and debilitating that they must stay in bed until the condition passes. Once the fluid builds up, patients experience sudden vertigo episodes that can last several hours.
This may be due to a vestibular migraine that causes people to see an “aura” around objects or people during an episode. This is called an acoustic neuroma and it’s often accompanied by progressive hearing loss, ringing of the ears (tinnitus) on either the left or right side of the head, and feelings of dizziness or imbalance.
There are two common variants: (1) acute otitis media (AOM) and (2) otitis media with effusion (OME). There is decreased movement of the eardrum on pneumatic otoscopy (insufflation of air into the ear canal).
Mastoiditis -- Patients with acute mastoiditis present with fever, ear pain, and a protruding auricle. Some patients hear 0 dB, but reaching the threshold of hearing usually requires louder test signals.
This is a consequence of the normal aging process and may vary widely from patient to patient. Type B demonstrates very poor compliance at any frequency, suggestive of a tympanic membrane (TM) immobilized by fluid in the middle ear or a TM perforation (no peak). Skull base osteomyelitis occurs most often in patients who are diabetic or immunocompromised. Rotatory chair testing is the “gold standard” for diagnosing bilateral vestibular weakness. Turning the head quickly or into a certain position, causes this free- floating material to move the endolymph in the inner ear, stimulating the vestibular division of the eighth cranial nerve. Sixty-seven patients with ISSHL, aged 52 years on average, were treated with tapered doses of oral prednisone and complete bed rest. In 1975, Siegel [3] was one of the few who did not consider vertigo to be an unfavorable prognostic sign. Imaging was part of the workup, with the purpose of excluding possible retrocochlear lesions, including demyelinating diseases. In 1993, Nakashima and Yanagita [5] studied 1,313 ISSHL patients and found that 30% had vertigo. On the basis of our results, we suggest that vertigo is not an adverse prognostic sign for the outcome of hearing, except in the case of high-frequency hearing loss.
It’s difficult to immediately pinpoint the reason for dizziness since there are a wide variety of factors and conditions that may cause dizziness. For people suffering from vertigo, a sudden head movement often results in a feeling of dizziness, lack of balance and vertigo.


Fortunately for most patients, inner-ear inflammation does eventually pass on its own without medication or treatment.
A vestibular migraine is often accompanied by feelings of dizziness, along with a strong headache and sensitivity to light and noise. Call us at 801-833-0579 to set an appointment with one of our trained balance specialists in Salt Lake City and Draper, Utah.
Ears Otitis media Hearing loss Otitis externa Vertigo Nose Sinusitis Allergic rhinitis Epistaxis Throat Strep. Common bacteria that cause acute OM in children are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Meningitis With increasing antibiotic resistance, especially Streptococcus pneumoniae, these complications may again become more common. Type C represents a tympanogram in which the compliance of the membrane is greatest at a point where the pressure in the canal is 200 mm of water below that of atmospheric pressure (peak shifted to the left). The patient is slowly spun in a rotating chair and dizzinessis is measured with optokinetic testing and a fixation test.
The Dix-Hallpike test is performed with the patient’s head rotated 45? toward the right ear, and the neck slightly extended with the chin pointed slightly upward. The patient will usually awaken with room-spinning vertigo that will gradually become less intense over 24–48 hours. The purpose of our study was to investigate whether there is a correlation between vertigo and the outcome of ISSHL. Craig Anderson is a board-certified ear, nose and throat doctor who specializes in balance and dizziness disorders and treats patients in our Salt Lake City, Draper, Park City and Tooele, Utah offices.
This movement can be as simple as sitting up from a prone position, rolling over in bed or quickly turning your head to one side. However, we strongly suggest you seek treatment and therapy to speed recovery from inner-ear inflammation that leads to vertigo. As a result, vestibular migraine sufferers may choose to stay in bed in a quiet, darkened room until their conditions improve.
In healthy children older than two years of age who present with less severe symptoms, observation for 48 hours may be considered. This suggests inefficient eustachian tube function with persistent negative pressure in the middle ear. The diagnosis is strongly suggested by a history of diabetes mellitus, severe otalgia, cranial neuropathies, and characteristic EAC findings. Moving platform posturography is a method of quantifying balance, but should not be used alone to diagnose vestibular disorders. Medical therapy with vestibular suppressants is ineffective because the episodes of vertigo are so fleeting, and should be discouraged. The patients were discharged after 10 days of complete bed rest when the daily prednisone dose reached 40 mg.
Mattox and Simmons [2] reported that a descending audiogram slope associated with vertigo was an unfavorable prognostic sign.
During the audiogram, independent thresholds are determined for each ear for both air conduction (conductive hearing) and bone conduction (sensorineural hearing).
It is most useful in quantifying balance improvement (or worsening) following treatment for a particular problem, and can help identify the functional dizzy patient.
Once the vertigo and the nystagmus provoked by the Dix-Hallpike test cease, the patient’s head is rotated about the rostral-caudal body axis until the left ear is down (panel B).
Clinical recovery was estimated by contrasting the audiometric results at admission and those at discharge 10 days later. The good news is that symptoms typically only last for a few weeks—but it can be a frustrating two weeks to endure and we recommend you seek treatment for vertigo. ECOG is not really a test of the vestibular system, but is a useful test of hearing in the evaluation of Meniere’s disease. The test is a variant of brainstem audio-evoked response and, if possible, should be performed during active Meniere’s attacks.
Values greater than or equal to the median of the group were considered significant with respect to improvement. With the head kept turned toward the left shoulder, the patient is rought into the seated position (panel D). Once the patient is upright, the head is tilted so that the chin is pointed slightly downward.



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