Clinical case · trainee

Chronic imbalance and oscillopsia with walking

Vignette

A 67-year-old retired gentleman presents with two years of progressive unsteadiness, falls in the dark and on uneven surfaces, and a sense that 'the world bounces' when he walks (oscillopsia). He took gentamicin intravenously for sepsis four years ago. Romberg sign is positive and worsened with eyes closed and on a foam pad. Head impulse test shows bilateral corrective saccades. Caloric testing shows bilaterally reduced responses (sum of maximum slow-phase velocities <12°/sec on each side). Audiometry is normal.

CDP findings

SOT pattern vs normal
BVPage norm 700255075100EQS82C1EO ·F73C2EC ·F71C3EO ·F·Sw51C4EO ·Sw6C5EC ·Sw5C6EO ·Sw·Sw
MCT — medium-amplitude backward translation
platform156 ms-100-500+50+100COP mm0200400600800100012001400BVP · backward · medium
ADT — sway energy across five trials per direction
sway energy025507510092T180T270T366T477T5Toes upadapting95T182T276T377T471T5Toes downadapting

Audiometric findings

Bilateral vestibulopathy after meningitis — severe bilateral sensorineural loss.

2505001k2k4k8kFrequency (Hz)020406080100Threshold (dB HL)NormalMildModerateMod-severeSevereProfoundRight (AC)Left (AC)

Bacterial meningitis is a classical cause of combined bilateral vestibulopathy and severe bilateral sensorineural hearing loss — both labyrinths are damaged by the same inflammatory or ischaemic process. The audiogram and CDP each document a severe deficit; together they argue for aggressive audiological habilitation (cochlear implantation candidacy) alongside vestibular rehabilitation.

Single-best-answer

Which CDP pattern is most consistent with this presentation?

Teaching point. Bilateral vestibulopathy (Bárány Society 2017 criteria) produces a stereotypical severe vestibular SOT pattern. Aminoglycoside ototoxicity is the most common identifiable cause. CDP findings parallel clinical severity and can be used to track rehabilitation progress.

References