A.A. is a 77 year old female, who is referred for gait disturbance and hearing loss. She describes unsteadiness and imbalance.  She says this began after a high-impact motor vehicle collision 10 years ago, but apparently the imbalance problem is progressively worsening.  Her daughter accompanied her to the evaluation, and reports that A.A. tends to veer off to the side while walking.

A.A. reports difficulty hearing, particularly in background noise.

Tympanograms show normal pressure and compliance, but wide slope gradients bilaterally, and acoustic reflexes are absent, ipsilaterally and contralaterally, bilaterally.

The audiogram shows mixed loss left, and sensorineural loss right.

• What reasons for conductive loss potentially affect the caloric test results, and which types of pathologies would not interfere with testing?

NU-6 Recorded

Case credits: Patricia Gaffney, AuD, Nova Southeastern University, was preceptor for this case.