Case 08 · clinician

Asymmetric hearing loss with mild imbalance over two years

Vignette

A 56-year-old engineer presents with two years of progressively worsening right-sided hearing loss and word discrimination out of proportion to his pure-tone audiogram. He reports mild imbalance with quick head movements but no rotational vertigo. Examination is unremarkable except for the audiogram. Bucket SVV is +1.5° (right) with a normal SD. Caloric testing shows a 65% right-sided weakness. Dynamic SVV (eccentric chair rotation) on the affected side produces a +5° tilt.

SVV trace

+1.5° ± 1.1°
SVV finding

Near-normal static SVV; dynamic SVV unmasks a 5° asymmetry

Why is the static SVV near-normal despite a 65% caloric weakness?

← Vertigo with a normal HIT and a normal SVVAll casesEpisodic vertigo, headache, and a wandering 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.

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© 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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