Ability to realize that the history is vital and can be very helpful in focusing your workup and ancillary testing such as audiogram, VNG, and imaging can provide helpful information. Multiple therapy modalities are available, including medications, lifestyle management, surgery, and physical therapy. Many patients with vertigo can be helped.

Vestibular migraine is a clinical diagnosis that can have variable presentation, with or without headache.  Care must be taken to consider it for any vestibular patient undergoing evaluation for surgical intervention.  Lifestyle changes such as stress reduction, diet modification, and improved sleep hygiene may help control some episodes.  Prophylactic and abortive medical therapies are available for vestibular migraine, but evidence is mixed with regards to their effects on vertigo.  The same is true of vestibular physical therapy.  Therapies involving monoclonal antibodies are promising,

Benign Paroxysmal Positional Vertigo (BPPV) is a common manifestation of vestibular dysfunction. A detailed history and physical examination is key to its diagnosis. Treatment by canal repositioning maneuvers is often successful. However, it is important to assess other risks factors associated with BPPV that may increase patient comorbidities. Rarely surgical intervention is warranted.

Meniere’s disease remains a challenge for otolaryngologists as the diagnosis hinges upon careful history taking and thorough knowledge of defining criteria.  Diagnostic testing may provide supportive evidence but there is no definitive test.  Conservative treatment is advised as there is expectation of decreasing symptoms over time.  Patients that require more significant intervention are managed with intratympanic therapies, reserving ablation for those with the most severe vertigo. 

Tinnitus is a phantom perception of sound that is primarily due to hearing loss or noise exposure.  However, multiple etiologies exist (TBI, somatic tinnitus, concussions) which can also trigger tinnitus and / or modulate tinnitus perception and distress.  Both central and peripheral lesions can lead to chronic tinnitus. Tinnitus can persist despite resolution of a hearing loss or loss of cochlear nerve function because it is generated in the central auditory pathways. A thorough physical exam and good history are crucial to determining the etiology of tinnitus.

Third window disorders are acquired or congenital bony defects of the inner ear that allow abnormal communication with the perilymphatic space. Vestibular and auditory symptoms result from a change in the balance between inner ear and middle ear transmitted pressures. Semicircular canal dehiscence, enlarged vestibular aqueduct and cholesteatoma perilymphatic fistula are just a few of the lesions that manifest third window inner ear phenomenon. High-resolution CT scanning is critical for diagnosis, and treatment options vary depending upon patient specific characteristics.

Sensorineural hearing loss affects a broad range of people and has a diverse etiology. It can be caused by congenital defects, insults in the perinatal period, familial causes, noise exposure, and can be a natural part of aging, among many other causes. Additionally, it can occur suddenly in unexpecting, otherwise healthy patients. In all situations, a thorough history, head and neck evaluation with otoscopy and an audiogram are reasonable first steps to evaluate the cause, type, and magnitude of hearing loss. In turn, this information will inform management options and counseling.

The external and middle ears are designed to amplify sound energy. When problems occur in those spaces it results in a conductive hearing loss. Understanding the anatomy and physiology of the external auditory canal, tympanic membrane, and ossicles are critical for an accurate conductive hearing loss diagnosis. The rehabilitation options depend on addressing the underlying pathology and trying to restore elements that can efficiently conduct sound energy. 

Cholesteatoma is a non-neoplastic expansile and erosive epithelial-lined cyst filled with keratin and desquamated debris. Chronic otitis media without cholesteatoma is characterized by a chronic and multifactorial inflammatory response. Complications of untreated disease may include chronic otorrhea, hearing loss, vertigo, facial nerve paralysis, pain, headache, and intracranial complications. Diagnosis is primarily clinical, and imaging studies are used to assess the disease extent before surgery or to evaluate for complications.

Acute otitis media is a common disease process, primarily seen in children. Since the introduction of vaccines, there has been a dramatic decrease in its complications, but the most common pathogens S. pneumoniae, H. influenza, and M. Catarrhalis continue to be prevalent. Treatment involves antibiotics and tympanostomy tubes, sometimes in conjunction with an adenoidectomy. Other treatment options such as steroids are controversial. Untreated acute otitis media can result in hearing loss and subsequent speech delay.