Audiology and Vestibular Medicine
Audiology and Vestibular Medicine
This domain tests audiogram interpretation, sudden hearing loss, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere disease. The exam expects bedside maneuver recognition and appropriate imaging.
Core rules
- A conductive loss shows an air-bone gap with normal bone conduction; sensorineural loss shows both air and bone thresholds reduced.
- Posterior canal BPPV is diagnosed with the Dix-Hallpike maneuver and treated with the Epley maneuver. Horizontal canal BPPV uses the supine roll test.
- Vestibular neuritis causes acute prolonged vertigo, nausea, and a positive head impulse test without hearing loss.
- Meniere disease causes episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness.
- Vestibular migraine causes recurrent vestibular symptoms with migraine features and requires a different treatment approach.
Worked example
A 60-year-old reports brief vertigo when rolling over in bed, lasting under 1 minute. Dix-Hallpike reproduces vertigo with upbeating torsional nystagmus. The diagnosis is posterior canal BPPV, and canalith repositioning is indicated. The reasoning is positional, brief vertigo with a characteristic maneuver response; routine MRI is not required for typical BPPV.
Traps
Do not order MRI for every typical BPPV case. Do not call vestibular neuritis if hearing is reduced. Do not use long-term vestibular suppressants instead of repositioning. Do not miss fluctuating hearing loss in Meniere disease.