Clinical case · trainee

Recurrent vertigo with low-frequency hearing loss

Vignette

A 56-year-old teacher reports a 2-year history of episodes of vertigo lasting 1–4 hours, occurring every 4–6 weeks, accompanied by left aural fullness and roaring tinnitus. Hearing tested between attacks shows fluctuating, low-frequency sensorineural loss on the left (35 dB HL at 250 Hz and 500 Hz, normal at higher frequencies). She is currently 10 days post her last episode. Bedside examination is unremarkable. Caloric testing shows a 32% left canal paresis. CDP is performed during this interictal period.

CDP findings

SOT pattern vs normal

MCT — medium-amplitude backward translation

ADT — sway energy across five trials per direction

Audiometric findings

Ménière's disease — characteristic low-to-mid-frequency sensorineural loss on the affected (right) ear.

Ménière's classically produces a low-to-mid-frequency sensorineural hearing loss on the affected ear, with relatively preserved high frequencies in early disease. The pattern fluctuates with attacks, particularly early in the disease course. Paired with an interictal CDP showing mild C5/C6 reduction on the same side, the audiometric and vestibular signatures are mutually supporting.

Single-best-answer

Which CDP finding is most consistent with the clinical picture?

Teaching point. Ménière's CDP fluctuates with disease activity. A single snapshot is less informative than serial assessments. The Bárány Society 2015 criteria for definite Ménière's require two or more spontaneous vertigo episodes lasting 20 minutes to 12 hours, audiometrically documented low-to-medium frequency SNHL in the affected ear, and fluctuating aural symptoms.