Objective: Acute spontaneous vertigo with idiopathic sudden sensorineural hearing loss (ISSNHL) can be diagnosed as labyrinthitis, which has a poorer prognosis than ISSNHL without vertigo. Thus, we aimed to identify the effect of the baseline vestibular function on the prognosis of labyrinthitis. Methods: A total of 23 patients with labyrinthitis was retrospectively divided into the recovered group (complete recovery, partial recovery) and the nonrecovered group (slight improvement, no improvement). Differences in caloric weakness and gain in the video head impulse test (vHIT) between the two groups were compared. In addition, the prognostic value of the vHIT on each of the three semicircular canals in predicting hearing recovery was analyzed using a linear regression model. Results: In final pure-tone audiometry, 2 patients (8.70%) exhibited complete recovery, 4 patients (17.39%) had partial recovery, and 17 patients (73.91%) had slight or no improvement. The initial ipsilesional posterior canal (iPC) gain and the contralesional anterior canal (cAC) gain were significantly decreased in the nonrecovered group ( p < 0.013 for iPC and p < 0.007 for cAC, Mann-Whitney U test). The mean hearing gain was positively correlated with the iPC gain (R 2 = 0.36, p = 0.003, Spearman correlation analysis). Conclusion: An abnormal iPC gain may be a poor prognostic factor for hearing recovery. Additionally, the vHIT on the three semicircular canals can provide prognosis and insights into the pathophysiological mechanisms in patients with labyrinthitis.

Objectives: This study aims to investigate the usefulness of the video head impulse test (vHIT) as a method for evaluating vestibular function in patients with unilateral chronic middle ear disease.Methods: Nineteen patients with various unilateral middle ear diseases including chronic otitis media (COM), COM with cholesteatoma, and adhesive otitis media successfully underwent preoperative vHIT. The gain of vestibuloocular reflex (VOR) and the presence of corrective saccades were compared between the affected ear and the healthy ear.Results: A total of eight male and 11 female patients with a mean age of 43.1 years were included in this retrospective study. Twelve ears had COM, four had COM with cholesteatoma, and three had adhesive otitis media. A positive history of vertigo or dizziness was reported in 36.8% of the cases. The VOR gain of the affected ears and the healthy ears were 0.97±0.16 vs. 1.00±0.08 in the horizontal canal, 0.91±0.11 vs. 0.87±0.11 in the anterior canal, and 0.87±0.17 vs. 0.99±0.12 in the posterior canal, respectively. Only VOR gain of the posterior canal was significantly decreased compared with healthy ears.Conclusions: The average VOR gains in the patients with chronic middle ear disease were within the pre-defined values of normality; however, when compared quantitatively, posterior canal gain of affected ears was significantly decreased compared to healthy ears. Our results can be explained by the anatomical proximity of the ampulla of the posterior canal and middle ear space.

ObjectiveTo expand our understanding of the pathophysiological mechanisms underlying vestibular neuritis and labyrinthitis by identifying any difference in the vestibulo‐ocular reflex for each semicircular canal.Study DesignRetrospective analysis.SettingThe Department of Otorhinolaryngology – Head and Neck Surgery, Chosun University Hospital, from January 2015 to December 2021.MethodsWe included 23 vestibular neuritis and 27 labyrinthitis patients who had been hospitalized. Pure‐tone audiometry, a bithermal caloric test, and a video head‐impulse test were performed within 5 days of symptom onset.ResultsIn the vestibular neuritis group, mean vestibulo‐ocular reflex gains were decreased to 0.51 in the ipsilesional horizontal canal and 0.55 in anterior canal, leading to marked asymmetry, whereas the gain of the ipsilesional posterior canal was relatively preserved at 0.85. In the labyrinthitis group, the mean vestibulo‐ocular reflex gain was 0.72 in the ipsilesional horizontal canal, 0.73 in the ipsilesional anterior canal, and 0.55 in the ipsilesional posterior canal. We observed statistical differences in the vestibulo‐ocular reflex gain and incidence of corrective saccades on the ipsilesional side in three semicircular canals between the groups (p = .002 for horizontal canal, p = .003 for anterior canal, and p < .001 for posterior canal). The receiver operating characteristic curve showed that pure‐tone audiometry, ipsilesional posterior canal gain, and gain asymmetry of posterior canal were excellent parameters for distinguishing labyrinthitis from vestibular neuritis.ConclusionVestibular neuritis and labyrinthitis patients have different degrees and patterns of video head‐impulse test involvement in the three semicircular canals, suggesting that the two distinct disorders may have different etiologies.

ObjectiveTinnitus is a common symptom of idiopathic sudden sensorineural hearing loss (ISSHL). This study aimed to investigate the characteristics and outcomes of acute tinnitus in patients with ISSHL.MethodsA total of 59 patients with ISSHL and acute tinnitus were enrolled. All patients underwent audiological assessment, tinnitus matching for loudness and frequency, and steroid treatment for sudden hearing loss. Tinnitus‐related distress was assessed using the tinnitus handicap inventory (THI) questionnaire. The outcomes of hearing recovery and tinnitus remission were investigated retrospectively.ResultsThe loudness and pitch of acute tinnitus were 63.2 ± 22.4 dB HL and 2010.63 ± 2368.99 Hz, respectively. Complete and partial recovery rates of acute tinnitus in ISSHL patients were 32.2% and 39% according to the THI scores. The group with complete recovery of hearing showed significantly greater improvement in tinnitus distress than the group with no improvement in hearing. The loudness and pitch of tinnitus did not correlate with tinnitus remission.ConclusionHearing recovery is more important for tinnitus remission than the psychoacoustic characteristics of acute tinnitus. Timely identification and proper treatment of hearing loss are important to improve tinnitus remission in patients with ISSHL.Level of EvidenceLevel 4.