Audiometry as a predictive proxy for balance dysfunction

Dizziness and vertigo are common complaints, often linked to inner ear or neurological issues. Although inner ear houses both the cochlea and vestibule, the relationship between hearing loss and vertigo is still a longstanding controversy. Here, we probed systematic audiometry and vestibular function on 1115 patients, attending consultation for dizziness and vertigo. Peripheral vestibular pathologies accounted for 49.3% of the diagnoses, while 41.1% were attributed to central pathologies. Principal component analysis identified six distinct audiometric phenotypes, which were then correlated with vestibular test outcomes. Caloric irrigation results demonstrated a correlation with hearing loss in the more affected ear. Rotatory chair testing was associated with overall hearing loss. Head impulse testing revealed that lateral and posterior semicircular canal function were age-dependent and correlated with high-frequency hearing loss. Notably, anterior semicircular canal function was independent of both audiometric phenotypes and age. We subsequently analyzed the distribution of audiometric phenotypes across diagnostic categories. Vestibular migraine (15.5% of the cohort) primarily affected younger women with normal hearing. Bilateral vestibulopathy (16.7% of the cohort), benign paroxysmal positional vertigo (9.7%), and dementia (2.2%) were more frequently observed in older patients and those with hearing loss. Ménière's disease (4%) and vestibular neuritis/labyrinthitis (3.9%) were associated with younger patients and unilateral or asymmetrical hearing loss. Our findings suggest that audiometric assessments can provide predictive insights into vestibular dysfunction. These audiometric phenotypes represent valuable tools for refining diagnoses and facilitating personalized management of patients with balance disorders.