Vertigo with hearing loss should not be ignored. This type of symptom cluster typically requires a thorough work up, including but not limited to a brain MRI and comprehensive hearing test.

When I evaluate a new patient who has vertigo with hearing loss, I usually refer them to my trusted otoneurology clinical partners for a full work up to determine the root cause of the vertigo with hearing loss.

Many times, medical management is appropriate in these cases. Medical management for vertigo with hearing loss may occur concurrently with vestibular physical therapy or instead of vestibular PT for these patients.

Root Causes for Vertigo with Hearing Loss

Medical or surgical management depends on the root cause.

One goal of the full work up is to rule out a stroke and an acoustic neuroma, which is a tumor of the vestibular nerve or cranial nerve eight.

Another possible root cause is vestibular labyrinthitis, which is a bacterial or viral infection or inflammation of the vestibular system in the inner ear. If this is the root cause of vertigo with hearing loss, then medications may be beneficial to minimize long term damage to the inner ear.

Other possible explanations of vertigo with hearing loss include true Meniere’s disease (idiopathic endolymphatic hydrops) a Meniere’s syndrome (secondary endolymphatic hydrops), and vestibular migraine event. In all of these cases, the hearing loss is typically temporary and resolves when the vertigo event ceases.

Vestibular Migraines

Sometimes, when you have vertigo with hearing loss, transient auditory symptoms can co-occur with dizziness or vertigo during a vestibular migraine, such as hearing ear ringing, ear fullness, and ear pain.

Interestingly, patients with cochlear migraine may even experience fluctuating hearing loss and ear fullness during a migraine episode, without any dizziness or vertigo.

There are many different types of migraines. Migraine episodes typically last between five minutes to three days — and may or may not include a headache. Patients may take several weeks to recover from a severe migraine episode.

Typically medical management for patients with migraine related dizziness or vertigo involves migraine medications and dietary changes. Some patients may also choose to incorporate certain supplements and various therapies into migraine management as well.

Meniere’s Disease

Another cause of vertigo with hearing loss could be Meniere’s Disease. True Meniere’s disease episodes typically last between 20 minutes and twelve hours. Over time, hearing can diminish in the affected ear leading to permanent hearing loss with multiple repeated Meniere’s attacks.

Therefore, medication management and dietary changes are key for patients with true Meniere’s disease to preserve hearing if possible. Reducing sodium and caffeine are often recommended to prevent Meniere’s attacks, along with proper medications.

Some patients with Meniere’s disease may even possibly surgery may be offered by doctors, such as triple semicircular canal plugging. Surgical options are sometimes offered to patients with Meniere’s disease, but various procedures may or may not preserve hearing.

Differential diagnosis between Meniere’s disease episodes and vestibular migraine episodes can present a challenge to health care providers. Some patients have both Meniere’s disease and migraines.

Both Meniere’s disease and migraines are associated with recurrent episodes of BPPV, so it is important to note if your vertigo with hearing loss symptom patterns change at any point.