Kos states that, in the diagnosis of vertigo, an auditory survey is most important. In addition, there should be an otoscopic and ophthalmic examination, x-rays of the internal auditory meatus, and caloric and neurologic examinations. It is important to differentiate between peripheral and central types of dizziness. Nearly all peripheral vestibular disturbances are accompanied by hearing loss; less frequently are the central ones. Recruitment, the Bekesy type audiogram, and auditory threshold fatigue are all helpful in differentiating between cochlear and neural lesions. In cochlear lesions there is recruitment, a short Bekesy excursion, and absence of threshold fatigue. Labyrinthine ischemia gives a high-frequency inner ear type of hearing loss which does not fluctuate and may or may not show recruitment. It is usually bilateral. Hearing loss is of high frequency and never fluctuates but progressively deteriorates. It is commonly associated with arteriosclerosis. In labyrinthian apoplexy, the vertigo is severe and constant
PROCTOR B, Portmann M, Bozzi E, Szpunar J, Hennecke TA. Chronic Progressive Deafness, Including Otosclerosis and Diseases of the Internal Ear: Summaries of the Bibliographic Material Available for 1955. AMA Arch Otolaryngol. 1959;70(3):373–407. doi:10.1001/archotol.1959.00730040381012
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