Patient:  I.F.

Age:  56

Gender:  Male

I.F. is a physician with a 6 year history of dizziness (not vertigo), lightheadedness and disequalibrium. He is having difficulty seeing patients because of these balance problems.  He reports that sudden head movement will provoke the dizziness, as does loud sound and pressure changes.  He believes that a head trauma precipitated the problems.  He has been been seen by two otologists.  Middle ear surgery was done for perilymphatic fistula; another diagnosis was of otosclerosis.  One of the prior audiograms is shown below.  He reports that he has had a VNG and was told it was normal.  MRI was also normal.

• Does either diagnosis (fistula or otoslerosis) coincide with the patient’s symptoms and audiologic results, or do you favor yet another diagnosis?
• What testing would contribute to your ability to make a differential diagnosis.