A 69-year-old man presented to the Emergency Department with 1 day of acute spontaneous vertigo, left-sided tinnitus and hearing loss. He had no otalgia, previous vertigo or hearing problems but did have a background of diabetes and hypertension. On examination, with fixation, there was no nystagmus, but without visual fixation (using Frenzel’s goggles), there was primary position left-beating nystagmus. The horizontal head-impulse test was negative, but his left Dix-Hallpike positional test was positive, provoking a paroxysm of up-beating, torsional nystagmus with vertigo. Otoscopy was normal with no vesicles. Weber’s test was positive to the right and Rinne’s was bilaterally negative. Smooth pursuit, saccades and cerebellar examinations were normal. Audiometry identified a left-sided profound and high-frequency and moderate-to-severe mid-frequency sensorineural hearing loss; right-ear audiometry identified only a mild high-frequency sensorineural hearing loss (figure 1A). He had acoustic reflexes in both ears at normal thresholds. Figure 1 (A) Asymmetric audiogram at initial presentation. Right ear shows a mild high-frequency sensorineural hearing loss, while the left ear shows a sloping mild-to-profound sensorineural hearing loss. (B) Left vestibular loss. Three-dimensional video head impulse at initial presentation shows isolated reduced left posterior semicircular canal vestibulo-ocular reflex gain (0.19) with catch-up saccades. (Gain values are listed to the top right of each individual head-impulse test.) (C) Repeat audiometry at 2 months. In comparison with the original audiogram, the right-ear results showed new upsloping severe-to-mild sensorineural hearing loss below 1 kHz and mild hearing loss above 1 kHz. The left-sided hearing has returned to normal at the low-to-mid frequencies after corticosteroid treatment. (D) Home audiometry over 45 days showing marked fluctuations in the right ear across the low-to-mid frequencies (≤1 kHz, red and orange traces). (E) The left ear shows little fluctuation in hearing loss. (F) Timeline of treatment. There was marked response in the left hearing loss, as …

中文翻译：

---

眩晕的可治疗原因

一名 69 岁男性因急性自发性眩晕、左侧耳鸣和听力损失 1 天就诊于急诊科。他没有耳痛、以前的眩晕或听力问题，但确实有糖尿病和高血压的背景。检查时，通过注视，没有眼球震颤，但没有视觉注视（使用 Frenzel 护目镜），有原位左搏性眼球震颤。水平头部冲击试验呈阴性，但他的左侧 Dix-Hallpike 位置试验呈阳性，引发了伴有眩晕的上跳、扭转性眼球震颤的发作。耳镜检查正常，无囊泡。Weber 的右侧测试呈阳性，Rinne 的双侧测试呈阴性。平稳追踪、眼跳和小脑检查均正常。测听确定左侧重度高频和中重度中频感音神经性听力损失；右耳测听仅发现轻度高频感音神经性听力损失（图 1A）。在正常阈值下，他的双耳都有声反射。图 1 (A) 初始呈现时的不对称听力图。右耳表现为轻度高频感音神经性听力损失，而左耳表现为轻度至重度倾斜感音神经性听力损失。(B) 左前庭功能丧失。初始演示时的 3D 视频头部脉冲显示左后半规管前庭眼反射增益 (0.19) 与追赶扫视孤立性降低。（增益值列在每个单独的头部脉冲测试的右上角。）（C）在 2 个月时重复测听。与原始听力图相比，右耳结果显示，低于 1 kHz 的新上坡重度至轻度感音神经性听力损失和高于 1 kHz 的轻度听力损失。皮质类固醇治疗后，左侧听力在中低频恢复正常。(D) 超过 45 天的家庭听力测量显示右耳在中低频（≤1 kHz，红色和橙色痕迹）中出现明显波动。(E) 左耳的听力损失波动很小。(F) 治疗时间表。左侧听力损失有明显反应，因为…… (D) 超过 45 天的家庭听力测量显示右耳在中低频（≤1 kHz，红色和橙色痕迹）中出现明显波动。(E) 左耳的听力损失波动很小。(F) 治疗时间表。左侧听力损失有明显反应，因为…… (D) 超过 45 天的家庭听力测量显示右耳在中低频（≤1 kHz，红色和橙色痕迹）中出现明显波动。(E) 左耳的听力损失波动很小。(F) 治疗时间表。左侧听力损失有明显反应，因为……