Case 06 · clinician

Fluctuating hearing and vertigo over 18 months

Vignette

A 51-year-old woman has had four episodes of vertigo over 18 months, each lasting 4–6 hours with associated left aural fullness and worsening of her low-frequency hearing loss. Between attacks she is symptom-free. Bucket SVV values across four visits: −3.5° (during attack), −2° (1 week later), −0.5° (1 month later), −3° (during the next attack two months later).

SVV trace

-3.5° ± 1.0°

Fluctuating ipsilesional tilt — larger during attacks, normalising between

What does the longitudinal SVV pattern tell you?

Autophony and a near-normal SVVAll casesVertigo with a normal HIT and a normal SVV
Subjective Visual Vertical

An interactive teaching atlas of Subjective Visual Vertical for the assessment of otolith-graviceptive function — bucket and digital technique, dynamic SVV, normal findings, and the tilt signatures of peripheral and central vestibular disease. Content synthesised from current Bárány Society criteria, peer-reviewed vestibular literature, and standard otoneurology texts.

→ Full references & acknowledgements
Built for

Medical students, ENT / Neurology / Audiology trainees, vestibular therapists, and clinicians who want to teach themselves the language of vertigo.

Concept & design
Dr Prahlada N.B

Karnataka ENT Hospital and Research Centre (R),
Champions Educational and Medical Society (R),
Amogh Foundation, Chitradurga, Karnataka, India

Please share your valuable feedback to:
prahladnb@kenthospitals.com

Disclaimer

For educational purposes only. Not for clinical use. The Subjective Visual Vertical chapter is an instructional resource intended to support learning about SVV and the assessment of otolith-graviceptive function. Clinicians remain completely responsible for the interpretation of findings, the formulation of a differential diagnosis, and any clinical decision. Nothing in this application replaces individualized assessment, hands-on training, expert consultation, or established practice guidelines.

© 2026 Dr Prahlada N.B · Karnataka ENT Hospital and Research Centre (R) · Champions Educational and Medical Society (R) · Amogh Foundation, Chitradurga, Karnataka, India
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