Acute Labyrinthitis — Dizziness, Vomiting & Hearing Loss OPD Case
A practical ENT case discussion for general practitioners and junior doctors: a 22-year-old male presents with acute dizziness, vomiting, and right-sided hearing loss. The clinical challenge is to identify acute labyrinthitis while actively excluding sudden sensorineural hearing loss and dangerous central mimics.
Why This Guide Matters
Vertigo without hearing loss is one problem. Vertigo with unilateral hearing loss is a different and more serious clinical territory. The hearing component localises the case toward the audiovestibular apparatus or CN VIII, but it also forces the clinician to exclude emergencies like sudden sensorineural hearing loss and AICA-territory posterior circulation stroke.
This guide trains the OPD habit of not writing “vertigo medicine” reflexively. Instead, it teaches you to classify acute audiovestibular syndrome, perform focused bedside examination, use HINTS appropriately, confirm the hearing loss, identify red flags, and refer early when hearing can still be saved.
Inside This Guide
- Acute audiovestibular syndrome — why dizziness, vomiting, and unilateral hearing loss belong together clinically.
- The central question — peripheral inner ear/CN VIII disease versus brainstem/cerebellar disease.
- Acute labyrinthitis logic — post-viral labyrinth inflammation involving both vestibular and cochlear function.
- SSNHL emergency — why acute unilateral sensorineural hearing loss needs urgent tuning fork tests, audiometry, and ENT referral.
- AICA stroke mimic — how posterior circulation stroke can produce vertigo, vomiting, and unilateral hearing loss together.
- Differential diagnosis map — Ménière’s disease, vestibular neuritis, vestibular migraine, MS, perilymph fistula, ototoxicity, otitis media, cholesteatoma, and schwannoma.
- Focused examination — vital signs, otoscopy, neurological screen, cerebellar signs, gait, nystagmus, HINTS/HINTS-plus logic, and bedside hearing tests.
- Investigation and referral plan — pure tone audiometry, urgent ENT referral, MRI when central signs appear, and when not to reassure.
Acute unilateral hearing loss is time-sensitive. Do not label the patient as “simple vertigo” until sudden sensorineural hearing loss and posterior circulation stroke have been actively considered.