Which diagnostic tests should be considered for a patient presenting with acute vertigo and hearing loss?

For a patient presenting with acute vertigo and hearing loss, the following diagnostic tests should be considered:

• Clinical assessment: Thorough history and examination to identify features suggestive of peripheral versus central causes of vertigo, including neurological signs and severity of symptoms ¹.
• Pure tone audiometry: To differentiate conductive from sensorineural hearing loss and to characterize severity and pattern of hearing loss ²,³.
• Magnetic Resonance Imaging (MRI) of the internal auditory meati: Recommended especially if there are localising symptoms or signs such as facial nerve weakness, or if there is asymmetrical sensorineural hearing loss (≥15 dB difference at two adjacent frequencies) to exclude vestibular schwannoma or cerebellopontine angle lesions ³.
• Brain imaging (MRI, CT, or MRA): Urgently indicated if central causes are suspected, such as new onset unilateral deafness with vertigo, neurological symptoms/signs, hyperacute onset vertigo, or red flag features suggestive of brainstem stroke ¹,⁴.
• Referral for specialist assessment: Urgent referral to ENT, audiovestibular medicine, or neurology depending on clinical findings and local pathways ¹,³,⁴.

Additional tests such as tympanometry may be performed as part of audiological assessment if indicated ³.