Expert: Harriet B Jacobster, Au.D. - 8/2/2009

Question
Hi Dr. Jacobster:

I got a diagnosis of Vestibular Neuritis two months ago, which was not to my knowledge NOT preceded by infection. I do have a history of seasonal allergy which peaks about the time of the attack. I have no noticeable hearing loss on the affected side.  The diagnosis was done using VNG, digital posturagraphy, and VAT by an MPT with certification in vestibular rehabilitation therapy, for which I did 12 sessions.  A neurologist confirmed the diagnosis in an office visit.  Later I was told by a Univ of California neuro-otologist in an email consult that VN diagnosis should be confirmed by MRI to the affected ear to rule out tumor on the vestibular nerve, and by an audiogram.  I had a whole head MRI which showed no central issues related to dizziness, but the MRI was not focused on the ear itself. My question is: what is the role of an audiogram in VN assessment for a person without hearing complaints after acute VN?  Can audiogram locate and characterize the site of the lesion or cause of the vestibular hypofunction and how would the results guide vestibular rehabilitation therapy?  Thank you.  Scott in Nevada.

Answer
Hi Scott,
I must agree with the neuro-otologist.  NOT getting an audiogram would be the same as having blurred vision and not getting the basic eye test.  An enormous part of the diagnostic picture is missing without the audiogram. Secondly, for even more accurate testing, the VNG etc., should have been done by a licensed audiologist whose focus is on diagnostics, not an MPT whose focus is on rehabilitation.  And, yes, you need the MRI to focus on the affected ear.  Additionally, the oto-neurologist will probably have the audiologist perform other auditory and balance function tests such as Otoacoustic Emissions and Auditory Brainstem Response audiometry.  Without these tests, it is too easy and common to miss the real cause, such as a possible tumor on the vestibular nerve.

In short, yes, I totally agree with the oto-neurologist and I would also recommend a true oto-neurological workup.

Hope this helps.
Dr. Harriet B. Jacobster, AuD
Board Certified in Audiology