Positional Nystagmus Tests Research Articles

Evaluation of Semicircular Canal Function Using Video Head Impulse Test in Patients With Peripheral Vestibular Disorders Without Nystagmus.

Objectives This study aims to evaluate semicircular canal function using video head impulse test (vHIT) in patients with peripheral vestibular disorders without nystagmus. Methods Patients who underwent vHIT were enrolled in this study, and the proportion of abnormal findings on vHIT in patients without nystagmus was investigated. In addition, the results of vestibular testing were investigated in cases in which both vHIT and caloric testing were performed in patients without nystagmus. Results Forty-six patients (23.4%) of 197 patients who had no abnormal findings on the nystagmus tests, including the gaze nystagmus test, positional nystagmus test, and positioning nystagmus test, showed dysfunction in at least one semicircular canal on vHIT. The most frequent diagnosis was vestibular schwannoma (14/46, 30.4%), and cases with bilateral vestibular dysfunction were also included (12/46, 26.1%). A disorganized pattern of catch-up saccade was observed more frequently in patients with subjective symptoms of dizziness/vertigo compared to those without subjective symptoms. Although the sensitivity of vHIT was low compared to caloric testing, vHIT could detect isolated vertical canal dysfunction not detected by caloric testing. Conclusions vHIT is considered to be a useful test for patients without nystagmus, as vHIT could detect abnormalities in approximately one-quarter of patients without nystagmus. vHIT is considered to be one of the first tests to be performed following nystagmus testing, including the gaze nystagmus test, the positional nystagmus test, and the positioning nystagmus test. On the other hand, there are some cases in which vHIT shows no abnormality while caloric testing shows canal paresis. It is necessary to perform vHIT, bearing in mind that there are abnormalities that cannot be detected by vHIT alone.

Acute vestibular syndrome associated with anti-GQ1b antibody

To delineate the clinical features and ocular motor findings in acute vestibular syndrome (AVS) associated with anti-GQ1b antibodies. We reviewed 90 patients with positive serum anti-GQ1b antibody in association with various neurological syndromes at Seoul National University Bundang Hospital from 2004 to 2018. The diagnoses included typical Miller Fisher syndrome (n = 31), acute ophthalmoplegia without ataxia (n = 27), Guillain-Barre syndrome with ophthalmoplegia (n = 18), AVS (n = 11), and Bickerstaff brainstem encephalitis (n = 3). Of them, the 11 patients with AVS formed the basis of this study. We also conducted a systematic review on AVS reported in association with anti-GQ1b antibody. Patients with AVS showed various ocular motor findings that included head-shaking nystagmus (n = 6), spontaneous nystagmus (n = 5), gaze-evoked nystagmus (n = 5), central positional nystagmus (n = 3), canal paresis (n = 2), and abnormal head-impulse tests (n = 1) without any internal or external ophthalmoplegia. Compared to those with other subtypes, patients with AVS mostly showed normal deep tendon reflexes (8 of 11 [73%], p = 0.002) and normal results on nerve conduction studies (4 of 4 [100%], p = 0.010). The clinical and laboratory findings resolved or improved markedly in all patients within 6 months of symptom onset. Systematic review further identified 7 patients with AVS and positive serum anti-GQ1b antibody who showed various ocular motor findings, including gaze-evoked nystagmus, saccadic dysmetria, central positional nystagmus, and ocular flutter or opsoclonus. Anti-GQ1b antibody may cause acute vestibulopathy by involving either the central or peripheral vestibular structures. AVS may constitute a subtype of anti-GQ1b antibody syndrome.

Audiovestibular findings in patients with Vogt-Koyanagi-Harada disease

Conclusion: The long-term follow-up study revealed a good audiovestibular prognosis in our patients with Vogt-Koyanagi-Harada disease (VKH) after adequate treatment. Objectives: To evaluate the audiovestibular findings and long-term prognosis of patients with VKH. Methods: A total of 82 ears in 41 patients (9 males and 32 females, aged 18–78 years) with VKH were examined in the audiovestibular study. Of the 41 patients, 16 patients with follow-up periods of more than 12 months (13–158 months) were included in the long-term follow-up study. Audiovestibular examinations included pure-tone audiometry; positional, positioning, and spontaneous nystagmus tests; and a caloric test. Results: Among the 41 patients, 28 (68%) complained of auditory symptoms at the initial visit and 28 (68%) showed sensorineural hearing loss (SNHL). Of the 24 patients who underwent nystagmus tests, only 3 (13%) presented with vestibular symptoms whereas 11 (46%) had nystagmus. Among 32 ears in 16 patients enrolled in the long-term follow-up study, 19 ears showed SNHL at the initial visit. The SNHL returned to normal in 14 ears (74%) and remained minimal in severity in the other 5 ears (26%) at the last visit. None of the patients showed persistent or repetitive vestibular symptoms.

A Case of Linear Scleroderma Involving Cerebellum with Vertigo

Linear scleroderma is a kind of disease that can cause complication of the central nervous system. Sometimes, ipsilateral intracerebral or white matter lesions in the brain magnetic resonance imaging are noted. Nystagmus is important for the differential diagnosis of dizziness. Positional nystagmus was classified into regular direction nystagmus, direction changing positional nystagmus (DCPN) and irregular nystagmus by their character. DCPN is defined as a nystagmus that changes its direction with different head and body positions, and it can be the sign of lesion in the central vestibular system. Recently, we experienced a 17-year-old woman who had a scalp linear scleroderma, treated for about 10 years and showed DCPN induced by positional nystagmus test. We report a case of linear scleroderma accompanied by cerebellar lesion with a brief review of literature.

Eye movement disturbance in multiple system atrophy: chronological study of 50 patients

To clarify the features of the eye movement disturbance in the patients with multiple system atrophy (MSA), we retrospectively examined chronological changes of 9 oculomotor parameters as described below in 50 MSA patients including 12 autopsied cases. Patients with MSA were consisted of 35 patients with cerebellar ataxia-preceding type and 15 patients with parkinsonism-preceding type. Nine parameters include saccade test, eye tracking test, positioning/positional/gaze/caloric nystagmus tests, and visual suppression test. Each parameter was evaluated by three categories; normal and the two abnormal findings according to their characteristic features. In all of the 9 parameters, no significant differences were found between the cerebellar ataxia- and the parkinsonism-preceding types of MSA both in the early (disease duration less than 3 years) and in the advanced stages (duration between 8 to 11 years). From the chronological analysis, 9 oculomotor parameters could be divided into three groups: the first group with the higher frequency of the abnormality from the early stage, the second with gradual increase of the frequency, and the third with less increased frequency even in the advanced stage. We here focused on the three representatives corresponding with the above-described each group; positioning nystagmus test mainly showing downbeat nystagmus as a first group, visual suppression test showing a qualitative change from depressed into increased response as the second, and the caloric nystagmus test showing decreased response as the third. Based on these chronological changes of the oculomotor parameters, we supposed that in MSA the dorsal vermis is involved at first, followed by the flocculus in the cerebellum, and then the degenerative lesions might expand to the vestibular nucleus, and the cerebral cortex including the vestibular cortex.

Diagnosis of the subtype and affected ear of benign paroxysmal positional vertigo using a questionnaire

Conclusion: The prediction of subtype and the affected ear of benign paroxysmal positional vertigo (BPPV) derived from the answers to our questionnaire can support the definitive diagnosis of BPPV. Objectives: We examined to what extent the diagnosis of subtype and the affected ear of BPPV judged from answers to a questionnaire agreed with the diagnosis decided by the results of the positional nystagmus test. Methods: We asked the following questions: ‘What kind of head movements induce vertigo?’ and ‘How long does the vertigo continue?’. As for the affected ear, we asked which ear was lower during stronger vertigo when induced in a supine position or during sleep. Results: The percentages of correct diagnosis speculated by the combined answers were 69% in posterior canal-type BPPV, 48% in BPPV with geotropic nystagmus, and 39% in BPPV with apogeotropic nystagmus. The percentage of correct diagnoses of the affected ear was more than 80%.

Medicare Proposes 2012 Outpatient Audiology Rates

You have accessThe ASHA LeaderBottom Line1 Aug 2011Medicare Proposes 2012 Outpatient Audiology Rates Mark Kander Mark Kander Google Scholar More articles by this author https://doi.org/10.1044/leader.BML2.16102011.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/110830/Medicare-Proposes-2012-Outpatient-Audiology-Rates.htm Medicare reimbursement rates for most hospital outpatient audiology services will change only slightly—from a decrease of 2% to an increase of 4%—under proposed 2012 payment rates. Rates for some procedures, however, including cochlear implantation and evoked otoacoustic emissions testing, are proposed to drop significantly. The Centers for Medicare and Medicaid Services (CMS) published the proposal in the July 18, 2011, Federal Register [PDF]. Regulatory comments are due Sept. 16. Unlike rates for speech-language pathology services, which are determined under the annual Medicare Physician Fee Schedule, rates for audiology outpatient services are determined by the hospital outpatient prospective payment system (OPPS). Under OPPS, audiology procedures are assigned to ambulatory payment classifications (APCs) that comprise services that are comparable clinically and with respect to cost. Although reimbursement for most audiology CPT™ codes (Current Procedural Terminology, © American Medical Association) will likely change only slightly, several vestibular function tests may increase by as much as 29%. These annual shifts in values are based almost entirely on national hospital cost records, although reportedly inaccurate recordkeeping often contributes to cost fluctuations that are unrelated to inflation and other CMS considerations. CMS proposes that CPT 92561 (Bekesy audiometry) and 92570 (acoustic immittance) be shifted to a higher-level APC (Level II Audiometry). This shift raises the payment level to $85, more than 250% of the current rate. This change was made because the median cost for these procedures has increased well beyond the median cost of their current APC. Conversely, CPT 92588 (evoked otoacoustic emissions) is proposed to shift to a different APC (Level I Otorhinolaryngologic Function Tests), reducing its payment level by 35% to $66. The shift is due to a significant reduction in the national median cost of the procedure. Other procedures in this APC include positional nystagmus tests and evoked otoacoustic emissions, limited, tests. It will be difficult for ASHA to contest this proposed change because the revision is based on hospital cost records. The proposed 2012 rate for auditory osseointegrated devices (i.e., bone-anchored hearing aids) with implantation is $9,056, a 5.35% increase. The payment rate for cochlear implantation (including the device) is proposed to drop by 12%, despite increases of more than 7% and 9% over the past two years, respectively. The proposed rate, $27,430, is based on hospital cost records. ASHA has, in the past, indicated to CMS that the lower reimbursement rate for cochlear implants will affect the accessibility of the procedure if outpatient programs are forced to close because of lack of financial viability. Author Notes director of health care regulatory analysis, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 10August 2011 Get Permissions Add to your Mendeley library History Published in print: Aug 1, 2011 Metrics Downloaded 39 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

A case of intractable benign paroxysmal positional vertigo

Although the duration of benign paroxysmal positional vertigo (BPPV) is generally short, it can sometimes be long and intractable. We report on a case of intractable BPPV in which the duration of disease was four years. The patient was a 38-year-old woman. She had suffered from bilateral hearing loss since childhood. Since October 2005, she experienced severe vertigo whenever she turned her head. She had consulted other doctors, but the symptoms persisted. On June 20, 2007, she was referred to the Otolaryngology Department of Tachikawa General Hospital. The positional nystagmus test demonstrated apogeotropic nystagmus in a bilateral position with a duration of more than one minute. Upbeat nystagmus with a clockwise direction (from the examiner) was seen in sitting position using the Dix-Hallpike method. A pure tone audiogram showed high tone damage causing sensorineural hearing loss bilaterally. A caloric test did not show canal paresis. Magnetic resonance imaging (MRI) of the brain showed normal findings. MRI of the inner ears showed narrowing throughout the entire semicircular canal bilaterally (mainly the bilateral anterior semicircular canals). The Brandt-Daroff method induced nausea; therefore that examination method was abandoned. Habitual training advocated by St. Marianna University, the Head shaking method from Yamaguchi University, and the Non-specific training method from Toho University did not improve the nystagmus. Vestibular training by Kitazato University improved her vertiginous feeling. The direction of nystagmus changed variously during the course. The vertiginous feeling had almost disappeared in June 2009, but nystagmus persisted. We considered that cupulolithiasis in the bilateral lateral semicircular canals often shifted to canalolithiasis in various portions of the semicircular canals. Appropriate physical therapy improved the subjective symptoms.

Nystagmus using video-oculography in psychiatric patients

To evaluate whether nystagmus has clinical significance in psychiatric patients who have functional and/or organic brain dysfunction. We performed gaze, positional and positioning nystagmus tests on 227 patients with psychiatric diseases (144 men, 83 women, with an average age +/- SD of 62.5 +/- 14.0 years) in order to evaluate the frequency and characteristics of nystagmus. Patients were classified according to the underlying disease. Normal control subjects were 107 subjects (26 men, 81 women, with an average age +/- SD of 35.6 +/- 10.0 years). Nystagmus was observed in 56 (24.7%) of 227 cases. Nystagmus was seen in 16 (59.3%) of 27 cases of alcoholism, 14 (22.2%) of 63 cases of organic psychiatric disorders, 25 (20.2%) of 124 cases of schizophrenia, 1 (20.0%) of 5 cases of excited mental retardation, 0 (0.0%) of 7 cases of mood disorders, 0 (0.0%) of 1 case of anxiety disorders and 1 (0.9%) of 107 subjects of normal control. There was a significant difference between psychiatric diseases and normal control. These results indicate that nystagmus may also be a very important clinical finding not only in patients with neurological and neuro-otological diseases, but also in patients with psychiatric diseases.

精神障害者における赤外線ＣＣＤカメラ眼振所見の検討

Nystagmus is an important clinical finding in patients with neurologic and neuro-otologic diseases. However, the clinical significance of nystagmus has not yet been well evaluated in psychiatric patients with functional/organic brain dysfunction. In the present study, we performed gaze, positional and positioning nystagmus tests in 144 patients with psychiatric diseases (101 men; 61.0±13.0 years) in order to evaluate the frequency and characteristics of nystagmus in these patients. Patients were classified according to the underlying diseases. Nystagmus was seen in 41 (28.5%) out of the 144 cases. Nystagmus was seen in 15 (62.5%) of the 24 cases of alcoholism, 9 (27.3%) of the 33 with organic psychiatric disorders, 16 (20.5%) of the 78 with schizophrenia, 1 (25.0%) out of the 4 with mental retardation, 0 (0.0%) out of the 4 with mood disorders, and 0 (0.0%) out of the 1 with anxiety disorders. These results suggest that nystagmus may be a very important clinical finding not only in patients with neurologic and neuro-otologic diseases, but also in patients with psychiatric diseases.

救急外来を受診しためまい症例の臨床統計

Between May 2004 and April 2006, 468 emergency patients with vertigo or dizziness consulted the otorhinolarygological emergency room of Tokyo Medical University. Patients with vertigo or dizziness comprised about 9% of the whole otorhinolaryngological emergency patients. The number of female patients was larger than that of male patients. About half of the patients were brought to our hospital by ambulance. Nystagmus was observed in 219 patients (46.8%). Incidence of nystagmus was highest on positional nystagmus test. Brain CT was obtained in 185 patients (39.5%), but there were no abnormal findings in any patients. The most frequent diagnosis was inner ear disorder (22%), followed by Menière's disease (7%), vestibular neuritis (6%), BPPV (6%). Cerebral infarction was observed in 1.9%.Eighty-four patients were admitted. Major diseases requiring admission were vestibular neuritis and inner ear disorder.In patients with cerebral infarction, brain CT was normal. These patients were all elderly males over 60 years old. Their nystagmus in the emergency room did not suggest central disorder, or they did not have other neurological findings. Neurological signs and symptoms appeared thereafter.In the emergency room, establishing a diagnosis by limited examination is difficult. Careful examination is necessary, since vertigo or dizzy patient with a central disorder can show sudden change.

Pathological localization of so-called posterior canal BPPV

Objective Based on the hypothesis that the origin of nystagmus is from the posterior canal (PC), the nystagmus in the head hanging and sitting position should be mirror images. To clarify the anatomical origin of positioning nystagmus in BPPV patients, we analyzed the positioning nystagmus of benign paroxysmal positioning vertigo (BPPV) patients three-dimensionally. Methods Twenty-six patients with BPPV participated in this study. The positioning nystagmus was recorded in complete darkness from the patient's left eye by means of an infrared CCD camera. We performed three-dimensional analysis of nystagmus using video image analysis system (VIAS). Subsequently, the rotation axis of the 3D eye movements of the positioning nystagmus was calculated. Results Among the 26 patients tested, 20 patients demonstrated the axes of nystagmus in good or relatively good alignment to the PC axis. However, in 11 of these 20 patients there was poor alignment of the axis of nystagmus in the sitting position to the PC axis. In addition, six patients showed axes of nystagmus with poor alignment to the PC in the head hanging position. Among them, two patients exhibited axes of nystagmus in good alignment with the anterior canal, in spite of diagnosis of these patients as PC BPPV by experienced examiner based on the positioning nystagmus test. Conclusion These results demonstrated that only one-third of patients who were diagnosed as BPPV, could be diagnosed as true BPPV which originates from a PC pathology. Besides the possibility that the pathology may originate from the AC, it is still unclear which part of the inner ear may be the candidate site of origin of the pathology of BPPV in the other 15 patients.

Equilibrium test findings in patients with Bell's palsy

Objective We analyzed equilibrium test findings in patients with Bell's palsy to confirm that such findings occur not only in patients with Hunt's syndrome but also in patients with Bell's palsy. Methods Subjects were 83 patients with Bell's palsy, 45 patients with Hunt's syndrome, and 82 patients with unilateral chronic otitis media without history of vertigo or ear surgery (for control). They were treated in our inpatient department and underwent equilibrium testing during the period 1983–2002. All subjects were at least 20 years of age. The following were analyzed: (1) presence of vertigo, (2) presence of abnormal equilibrium test findings, (3) relation between the degree of paralysis and abnormal equilibrium test findings, and (4) relation between the degree of recovery from paralysis and abnormal equilibrium test findings. Equilibrium testing consisted of a gaze nystagmus test, a spontaneous nystagmus test, positional and positioning nystagmus tests, and a caloric test. The incidence of abnormal findings in each test was compared between the three groups. Results Abnormal equilibrium test findings were observed in patients with Bell's palsy. No association was observed between the results of equilibrium tests and the degree of facial paralysis in patients with Bell's palsy. However, some of the equilibrium test results were significantly associated with the degree of facial nerve recovery. Conclusions Although our study was limited in its lack of true control subjects, our data suggest that patients with Bell's palsy show a significantly high incidence of vestibular abnormalities.

回旋性眼振を認めた脳幹悪性リンパ腫の一例

Recently, the method for diagnosis of benign proximal positional vertigo (BPPV) improved by the spread of infrared charge-coupled device (CCD) cameras. However, central positional vertigo may be involved in cases of positional vertigo and it is necessary to perform the diagnosis carefully.Since we experienced a case of brainstem malignant lymphoma with rotatory nystagmus in the positioning nystagmus test on the first medical examination, we reported the case. Although the chief complains were a floating sensation, nausea, and vomiting, along with medical treatment progress, the condition has improved gradually and rotatory nystagmus has also disappeared.

Diagnosis and Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Describe the diagnosis, treatment, and outcome of a group of 20 patients with lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). Retrospective review of 20 patients with LSC-BPPV (10 with geotropic and 10 with apogeotropic nystagmus) presenting to a tertiary balance center. Diagnosis was confirmed with infrared nystagmography in Dix-Hallpike positioning tests and supine positional tests. Patients were treated with one or more particle repositioning maneuvers. Addition of supine positional nystagmus tests to Dix-Hallpike positioning testing improves sensitivity in the diagnosis of LSC-BPPV. Treatment outcomes in the apogeotropic LSC-BPPV group were poorer than the geotropic LSC-BPPV group. Adding supine positional testing to routine vestibular diagnostic testing will increase the identification of LSC-BPPV. Apogeotropic LSC-BPPV is more challenging to treat.

簡易検査では異常のないめまい症例の診断

Vertigo is thought to be a symptom which generally is hard to understand. There is no problem when there are some abnormal findings in equilibrium function tests, represented by characteristic nystagmus and CP. When encountering vertigo cases with rare abnormal findings, a short-term attack of vertigo and few objective findings, there are many patients for whom considerable effort is made on and explanation. We investigated clinically the treatment of vertigo cases which showed no abnormal findings.The subjects were 21 patients who were treated in former ENT clinic as unknown vertigo or vestibular disorder. Vertigo cases are classified into peripheral vertigo, central vertigo, functional vertigo and other vertigo. Vertigo can be classified into those types of vertigo based on the pattern of vertigo attack. It is indispensable in the treatment of vertigo to confirm the existence of nystagmus with the positional and positioning nystagmus test by Frenzel glasses and infrared CCD camera. Though a flow chart type index is useful for vertigo, we must recognize the existence of serious pitfalls in it. The precise of vertigo is essential for effective treatment of vertigo. The diagnosis study for vertigo contributes to further development and establishment for patients who suffer from intense vertigo.

Walk-rotate-walk test identifies patients responding to Lempert's maneuver, with benign paroxysmal positional vertigo of the horizontal canal

Two hundred and fifteen patients were diagnosed and treated for benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC). All patients were tested with conventional positional nystagmus tests lying supine and rotating head for geotropic nystagmus, registered with Frenzels glasses, and in 109 cases with ENG. The walk-rotate-walk (WRW) test, developed by one of us (T.R.) and described in the text, was applied to all patients. The immediate good treatment results with Lempert's maneuver verify the correct diagnosis of BPPV-HC. The WRW test is a more sensitive test for BPPV-HC than earlier positional tests. The unhabituated acute phase of vestibular neuritis shows positive test results and must be eliminated with caloric tests. The WRW test identifies as a dynamic test patients with symptoms of even lesser magnitude, where the compensatory capacity of the equilibrium system suppresses the diagnostic findings with earlier positional horizontal canal tests.

後半規管遮断術を行った頭位性めまいの一例

Positional vertigo of peripheral origin usually resolves by itself or by conservative treatments. However, some cases resist conventional treatments and show disabling vertigo. The case presented herein is a 57-year-old woman who developed positional vertigo following head injury. She showed direction-changing vertical-rotatory nystagmus upon positional nystagmus test. Drug therapy and physical maneuver failed to control her symptoms and nystagmus. Canal plugging procedure to the right posterior semicircular canal successfully eliminated the vertigo and the nystagmus. The hearing remained unchanged. Close analysis of nystagmus is necessary for the precise diagnosis of the affected organ and selection of the appropriate treatment.

急激な両側前庭機能低下と難聴を呈した１例

Although unilateral loss of hearing and vestibular function is relatively common, bilateral auditory and vestibular dysfunction rarely occurs. We report a patient with bilateral auditory and vestibular dysfunction with simultaneous onset and describe the otological manifestations of this case. A 54-year-old man was admitted to hospital complaining of headache and fever. After hospitalization, he experienced vertigo, which consisted of a sensation of moving vertically and noticed bilateral hearing loss, which increased gradually. The patient was referred to our University Hospital because vertigo and hearing loss persisted after therapy, although his headache and fever improved. On the first visit to our clinic, skin eruptions suggestive of herpes virus infection were noted on the right cheek and around the angles of the mouth. Pure-tone audiometry revealed moderate to severe bilateral sensorineural hearing loss. Right-beating nystagmus with horizontal and torsional components was observed on gaze, positional and positioning nystagmus tests. A caloric test showed severe hypofunction of the bilateral semicircular canals. Hematological examination revealed an elevated antibody titer against herpes simplex virus. Steroid tapering treatment and prostaglandin treatment were performed and the he hearing level improved to 63.8dB on the right and 32.5dB on the left, and nystagmus on gaze, positional and positioning conditions disappeared. A caloric test after therapy showed mild canal dysfunction on the right and severe canal palsy on the left. At present, the patient does not have any marked disabilities in daily life. We speculated that the sudden loss of bilateral auditory and vestibular function was caused by herpes simplex viral meningitis because of the skin eruptions on the face and elevated antibody titer against herpes simplex virus.

めまいを伴った突発難聴を初発症状とした急性散在性脳脊髄炎の一症例

We report a patient with vertigo and sudden hearing loss due to acute disseminated encephalomyelitis (ADEM).A 17-year-old male complained of sudden hearing loss in the right ear and dizziness subsequent to symptoms resembling those of a common cold. To his recall, he had never manifested any previous neurological disturbances. Audiometric testing revealed severe sensorineural hearing loss in his right ear and mild sensorineural hearing loss in his left ear. In addition, a short increment sensitivity index (SISI) test was positive bilaterally. Neuro-otological examinations revealed horizontal-rotating nystagmus and upbeat nystagmus on positional and/or positioning nystagmus tests. Although pursuit eye movement was normal, the optokinetic nystagmus was impaired and fast-phase velocity of the nystagmus was reduced. Caloric tests revealed severe hypofunction bilaterally. MRI showed patchy high-intensity areas in the pons, left frontal lobe, left superior frontal gyrus, and left parietal lobe on T2-weighted and FLAIR (fluid attenuated inversion recovery) images.Based on the history, physical examinations, laboratory tests, and MRI findings for this patient, he was diagnosed as having ADEM with bilateral inner ear lesions. This patient was considered to be an unusual case of ADEM complicated with cochlear and vestibular signs. To our knowledge, such a case has not been previously reported.