Causative factors and epidemiology of bilateral vestibulopathy in 255 patients

In their study of bilateral vestibulopathy, Zingler and colleagues employed standard bedside tests to screen for hearing loss: asking patients whether they had impaired hearing and whispered speech. We recently showed that these and other bedside tests are poor screening tools for detecting clinically significant hearing loss. In our study, asking patients whether they had difficulty hearing and whispered speech had sensitivities of only 0.27 (95% confidence interval, 0.19–0.37) and 0.46 (95% confidence interval, 0.36–0.56), respectively, to detect a hearing loss of more than 40dB by pure-tone audiometry. Yet, both of these tests had a high specificity of 0.89 and 0.78, respectively, consistent with Zingler and colleagues’ findings. Of the 255 patients these authors tested, 80 had an abnormal bedside hearing test that almost always (98%) was sensorineural based on pure-tone audiometry. Given the poor sensitivity of bedside hearing tests, it is likely that more patients in their sample had hearing loss, which may have had diagnostic importance, particularly in light of the relatively large number of patients for whom no cause for bilateral vestibulopathy could be established. When it is important to know the status of a patient’s hearing, we recommend performing an audiogram because many patients who “pass” bedside hearing tests nevertheless have a hearing loss.