Which diagnostic tests should be considered for a patient presenting w

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

For a patient presenting with acute vertigo and hearing loss, the following diagnostic tests should be considered:

Clinical assessment: Thorough history and examination to identify features suggestive of peripheral versus central causes of vertigo, including neurological signs and severity of symptoms .
Pure tone audiometry: To differentiate conductive from sensorineural hearing loss and to characterize severity and pattern of hearing loss ,.
Magnetic Resonance Imaging (MRI) of the internal auditory meati: Recommended especially if there are localising symptoms or signs such as facial nerve weakness, or if there is asymmetrical sensorineural hearing loss (≥15 dB difference at two adjacent frequencies) to exclude vestibular schwannoma or cerebellopontine angle lesions .
Brain imaging (MRI, CT, or MRA): Urgently indicated if central causes are suspected, such as new onset unilateral deafness with vertigo, neurological symptoms/signs, hyperacute onset vertigo, or red flag features suggestive of brainstem stroke ,.
Referral for specialist assessment: Urgent referral to ENT, audiovestibular medicine, or neurology depending on clinical findings and local pathways ,,.

Additional tests such as tympanometry may be performed as part of audiological assessment if indicated .

Which diagnostic tests should be considered for a patient presenting with acute vertigo and hearing loss?