Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement.

PURPOSE: Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity. STUDY DESIGN: This was a prospective cohort study. METHODS: Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined. RESULTS: The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics. CONCLUSIONS: Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.

Two-phase survey on the frequency of use and safety of MRI for hearing implant recipients.

PURPOSE: Magnetic resonance imaging (MRI) is often used to visualize and diagnose soft tissues. Hearing implant (HI) recipients are likely to require at least one MRI scan during their lifetime. However, the MRI scanner can interact with the implant magnet, resulting in complications for the HI recipient. This survey, which was conducted in two phases, aimed to evaluate the safety and performance of MRI scans for individuals with a HI manufactured by MED-EL (MED-EL GmbH, Innsbruck, Austria). METHODS: A survey was developed and distributed in two phases to HEARRING clinics to obtain information about the use of MRI for recipients of MED-EL devices. Phase 1 focused on how often MRI is used in diagnostic imaging of the head region of the cochlear implant (CI) recipients. Phase 2 collected safety information about MRI scans performed on HI recipients. RESULTS: 106 of the 126 MRI scans reported in this survey were performed at a field strength of 1.5 T, on HI recipients who wore the SYNCHRONY CI or SYNCHRONY ABI. The head and spine were the most frequently imaged regions. 123 of the 126 scans were performed without any complications; two HI recipients experienced discomfort/pain. One recipient required reimplantation after an MRI was performed using a scanner that had not been approved for that implant. There was only one case that required surgical removal of the implant to reduce the imaging artefact. CONCLUSION: Individuals with either a SYNCHRONY CI or SYNCHRONY ABI from MED-EL can safely undergo a 1.5 T MRI when it is performed according to the manufacturer's safety policies and procedures.

Benign Paroxysmal Positional Vertigo.

Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin. Calcium homeostasis has also been shown to contribute to the pathogenesis of the disorder by creating an environment in which otoconia are more prone to dislodging from their native gelatinous substrate. Recent findings have served to identify variant-specific provocative tests with the greatest diagnostic utility while simultaneously maximizing their diagnostic yield. Current data have also helped elucidate the efficacy of repositioning maneuvers and surgical interventions. Summary: BPPV is a disease of altered endolymph and cupular mechanics secondary to dislodged otoconia. It is amenable to particle repositioning maneuvers in most instances or surgical occlusion for intractable cases.

Stapedectomy Versus Stapedotomy.

Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates. Modified stapes mobilization procedures may represent the next major development in stapes surgery in a selected patient population.

Intratympanic Dexamethasone in the Treatment of Ménière's Disease: A Comparison of Two Techniques.

OBJECTIVE: To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Ménière's disease. STUDY DESIGN: Prospective case series. SETTING: Tertiary neurotology clinic. PATIENTS: One hundred six consecutive adult patients with definite unilateral Ménière's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment. INTERVENTIONS: Two different IT Dex regimes, either a single injection or a series of four injections, that were subsequently repeated as indicated. MAIN OUTCOME MEASURE: Requirement for subsequent ablative therapy in the form of intratympanic gentamicin, vestibular nerve section, or labyrinthectomy. Hearing outcomes were measured using pure-tone average of 0.5, 1, 2, and 3 kHz on standard audiometry. RESULTS: The number of intratympanic dexamethasone injections per patient ranged from 1 to 29 (median = 4). Using the Kaplan-Meier method, predicted survival (patients not requiring ablative therapy) at 2 and 4 years after initial treatment was 83.9 and 79.3%, respectively. The injection series protocol ultimately yielded 5% better survival than the single injection protocol, but this was not statistically significant. Injections did not protect against hearing loss, and the most recent pure-tone averages declined compared with pretreatment values by an average of 8.27 dB (p < 0.05). The treatments did not result in any acute hearing losses, permanent tympanic membrane perforations, or other significant adverse events. CONCLUSION: Intratympanic dexamethasone injections were successful in controlling vertigo insofar as they were able to obviate ablative therapy in the majority of Ménière's disease patients in this study. The injection series protocol may have been more beneficial compared with the single injection, although the difference between the two protocols was nonsignificant. Hearing mildly declined over the treatment course, which likely represents natural disease progression. The lack of adverse events suggests that IT Dex may be a nonablative option for patients with bilateral disease or only hearing/vestibular ears.

Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT.

HYPOTHESIS: The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea. BACKGROUND: An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed. METHODS: Clinical and micro-CT images of 20 cadaveric cochleae were acquired. Four specialists measured A-values on clinical CT images using both standard views and multiplanar reconstructed (MPR) views. Measurements were repeated to assess for intraobserver variability. Observer variabilities were evaluated using intra-class correlation and absolute differences. Accuracy was evaluated by comparison to the gold standard micro-CT images of the same specimens. RESULTS: Interobserver variability was good (average absolute difference: 0.77 ±â€Š0.42 mm) using standard views and fair (average absolute difference: 0.90 ±â€Š0.31 mm) using MPR views. Intraobserver variability had an average absolute difference of 0.31 ±â€Š0.09 mm for the standard views and 0.38 ±â€Š0.17 mm for the MPR views. MPR view measurements were more accurate than standard views, with average relative errors of 9.5 and 14.5%, respectively. CONCLUSION: There was significant observer variability in A-value measurements using both the standard and MPR views. Creating the MPR views increased variability between experts, however MPR views yielded more accurate results. Automated A-value measurement algorithms may help to reduce variability and increase accuracy in the future.

Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo.

OBJECTIVES/HYPOTHESIS: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder with an incidence between 10.7 and 17.3 per 100,000 persons per year. The mechanism for BPPV has been postulated to involve displaced otoconia resulting in canalithiasis. Although particulate matter has been observed in the endolymph of affected patients undergoing posterior canal occlusion surgery, an otoconial origin for the disease is still questioned. STUDY DESIGN: In this study, particulate matter was extracted from the posterior semicircular canal of two patients and examined with scanning electron microscopy. METHODS: The samples were obtained from two patients intraoperatively during posterior semicircular canal occlusion. The particles were fixed, stored in ethanol, and chemically dehydrated. The samples were sputter coated and viewed under a scanning electron microscope. Digital images were obtained. RESULTS: Intact and degenerating otoconia with and without linking filaments were found attached to amorphous particulate matter. Many otoconia appeared to be partially embedded in a gel matrix, presumably that which encases and anchors the otoconia within the otolith membrane, whereas others stood alone with no attached filaments and matrix. The otoconia measured roughly 2 to 8 µm in length and displayed a uniform outer shape with a cylindrical bulbous body and a 3 + 3 rhombohedral plane at each end. CONCLUSIONS: These findings suggest that the source of the particulate matter in the semicircular canals of patients with BPPV is broken off fragments of the utricular otolithic membrane with attached and detached otoconia. LEVEL OF EVIDENCE: NA Laryngoscope, 127:709-714, 2017.

Pentoxifylline-tocopherol-clodronate combination: A novel treatment for osteoradionecrosis of the temporal bone.

BACKGROUND: Osteoradionecrosis (ORN) of the temporal bone is a complication of radiation therapy that is extremely challenging to manage. METHODS: We report the case of a patient treated at our institution and present a review of the literature. RESULTS: A 52-year-old woman presented with ORN of the temporal bone 20 years after radiation therapy for an ipsilateral parotid tumor. She failed conservative management, including serial debridements, oral and topical antibiotics/antifungals, and aural lavage. As an alternative to hyperbaric oxygen (HBO) and/or temporal bone resection, treatment with pentoxifylline-tocopherol-clodronate combination (PENTOCLO) was pursued and her condition improved dramatically. CONCLUSION: This is the first document use of PENTOCLO to treat ORN of the temporal bone. PENTOCLO may represent an effective nonsurgical management option for ORN of the temporal bone.

Round window reinforcement for superior semicircular canal dehiscence: a retrospective multi-center case series.

PURPOSE: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity. RESULTS: Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery. CONCLUSION: RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.

Cisplatin otoprotection using transtympanic L-N-acetylcysteine: a pilot randomized study in head and neck cancer patients.

OBJECTIVES/HYPOTHESIS: To evaluate the feasibility and efficacy of transtympanic L-N-Acetylcysteine (L-NAC) administration in patients receiving cisplatin chemotherapy for head and neck cancer. STUDY DESIGN: Prospective randomized nonblinded open-label clinical trial. METHODS: Transtympanic 2% L-NAC was administered to one randomly selected ear with the other ear as control in each patient. Primary outcome parameter was the difference in the loss of pure tone averages (PTA) at 2, 4, and 8 kHz between the L-NAC and control ear at 1 to 2 months following chemotherapy. RESULTS: Eleven patients completed the study, with two patients demonstrating significantly better hearing in the L-NAC treated ear (18.2%). However, for the overall group, the difference in hearing preservation did not reach significance. Two percent L-NAC administration was well tolerated in this patient population. There were no adverse effects associated with L-NAC. CONCLUSION: Although the study did not demonstrate a significant benefit overall, transtympanic L-NAC was associated with significantly better hearing in two patients. Better delivery methods may improve the efficacy of this treatment. L-NAC remains a promising drug in preventing cisplatin-induced ototoxicity.

Endolymphatic sac surgery versus intratympanic gentamicin for the treatment of intractable Ménière's disease: a retrospective review with survey.

OBJECTIVES: 1) To review a 10-year experience of endolymphatic sac surgery (ESS) and intratympanic gentamicin (ITG) for intractable Ménière's disease (MD), and 2) to compare preoperative and postoperative outcomes. DESIGN: Retrospective chart review and survey. SETTING: Tertiary care center. PATIENTS: Patients treated with ESS or ITG between 1997 and 2007 at London Health Sciences Centre were eligible for recruitment. INTERVENTIONS: ESS or ITG. MAIN OUTCOMES: 1) 1995 American Academy of Otolaryngology-Head and Neck Surgery hearing stage, vertigo class, and functional level; and 2) a 40-item validated quality-of-life questionnaire (MD Outcome Questionnaire). STATISTICAL ANALYSES: Chi-squared and t tests. RESULTS: Sixty-seven patients were recruited (n = 30 ESS; n = 37 ITG). Preoperatively, the ITG group had poorer hearing stage (p = 0.03). There were no differences between groups on preoperative functional level and QOL measures. Postoperatively, ESS patients reported more tinnitus (p = 0.003) and aural fullness (p = 0.01). There were no differences in posttreatment vertigo class. Secondary treatment was required for 27% of patients in the ESS compared with 3% in the ITG. Posttreatment hearing remained unchanged for the ITG and was overall decreased in the ESS group (p = 0.03). Participants in the ITG reported better postoperative functional levels (p = 0.02) and higher global (p = 0.04), social (p = 0.001), and overall QOL scores (p = 0.03). CONCLUSION: ITG, compared with ESS, reveals better posttreatment functional levels, and superior global, social, and overall QOL scores. Although no statistical difference in vertigo class, a clinical difference is observed.

Recent advances in viral inner ear disorders.

PURPOSE OF REVIEW: To highlight the recent advances in the understanding of the diagnosis and management of viral inner ear disorders. Congenital sensorineural hearing loss (cSNHL), sudden sensorineural hearing loss (SSNHL), Ménière's disease, and vestibular neuritis/viral labyrinthitis are discussed. RECENT FINDINGS: Cytomegalovirus infection during pregnancy is an under-recognized cause of hearing loss and central nervous system disease amongst the general population. Prevention of maternal infection and treatment of affected newborns with ganciclovir are promising interventions. Recent evidence in SSNHL patients has resulted in recommendations against viral serology or the use of antivirals. There appears to be an increased risk of SSNHL in patients with comorbid hypertension and diabetes. The viral hypothesis of Ménière's disease remains unproven. In patients with an acute episode of vestibular neuritis, there is presently not sufficient evidence to support the routine use of corticosteroids or antiviral medications. SUMMARY: cSNHL remains the most clearly defined of the viral inner ear disorders. The evidence for viral involvement in SSNHL, Ménière's disease, and vestibular neuritis is indirect and equivocal. This review highlights the recent advancements in the diagnosis and management of these disorders.

Audiology in the sudden hearing loss clinical trial.

OBJECTIVE: To report the pretreatment and posttreatment population characteristics and the overall stability of the audiologic outcomes found during the Sudden Hearing Loss Clinical Trial (ClinicalTrials.gov: Identifier NCT00097448). STUDY DESIGN: Multicenter, prospective randomized noninferiority trial of oral versus intratympanic (IT) steroid treatment of sudden sensorineural hearing loss (SSNHL). SETTING: Fifteen academically based otology practices. PATIENTS: Two hundred fifty patients with unilateral SSNHL presenting within 14 days of onset with 50 dBHL or greater pure tone average hearing threshold in the affected ear. INTERVENTION: Either 60 mg/d oral prednisone for 14 days with a 5-day taper (121 patients) or 4 IT doses for 14 days of 40 mg/ml methylprednisolone (129 patients). MAIN OUTCOME MEASURE: Primary end point was change in hearing [dB PTA] at 2 months after treatment. Noninferiority was defined as less than 10 dB difference in hearing outcome between treatments. In this article, pretreatment and posttreatment hearing findings will be reported in detail. RESULTS: A general (and stable) effect of treatment and a specific effect of greater improvement at low frequencies were found in both treatment groups. CONCLUSION: Hearing improvements are stable, and a significantly greater improvement occurs with lower frequency after either oral or IT steroid treatment of SSNHL.

Transmastoid semicircular canal occlusion: a safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence.

OBJECTIVES/HYPOTHESIS: Transmastoid occlusion of the superior semicircular canal in superior semicircular canal dehiscence (SSCD) syndrome and the posterior semicircular canal in intractable benign paroxysmal positional vertigo (BPPV) will produce resolution of preoperative symptoms. STUDY DESIGN: Retrospective review, quality assurance. METHODS: Sixteen patients with SSCD and 61 patients (65 ears) with intractable BPPV who underwent canal occlusion were reviewed. All patients underwent occlusion of the affected semicircular canal through a transmastoid approach. RESULTS: Preoperative symptoms (vestibular, 13 patients; pulsatile tinnitus, 2 patients; or hyperacusis, 1 patient) were greatly improved or completely resolved in 15 of the 16 SSCD patients who underwent transmastoid occlusion of the superior canal. Hearing was preserved in 14 patients and improved in two patients. Vestibular symptoms were resolved in all intractable BPPV patients who underwent transmastoid occlusion of the posterior canal. One patient had a late recurrence of atypical BPPV. Almost all BPPV patients with normal preoperative hearing have an initial transient postoperative hearing loss, which when tested for is usually a mild to moderate mixed loss. Delayed sensorineural hearing loss was noted in three patients; one loss was profound whereas two were mild. CONCLUSIONS: The transmastoid approach to canal plugging is successful in the treatment of symptoms in both SSCD and intractable BPPV, and is a familiar approach for the otologist. This is a viable alternative to the middle fossa approach for SSCD, thereby avoiding a craniotomy. Transmastoid is the definitive approach for posterior canal occlusion.

Efficacy and safety of bilateral posterior canal occlusion in patients with refractory benign paroxysmal positional vertigo: case report series.

OBJECTIVE: To highlight the effectiveness, safety, and adverse effects of treating intractable posterior canal benign paroxysmal positional vertigo (BPPV) with bilateral posterior canal occlusions. PATIENTS: Included in this study are 6 patients diagnosed with bilateral BPPV refractory to medical treatment and particle repositioning maneuvers (PRMs) who underwent bilateral posterior semicircular canal occlusions. Patients were selected from tertiary hospital referral centers in London, Ontario, Canada, and St. Louis, Missouri, USA. INTERVENTIONS: This study used the following interventions: preoperative and postoperative audiogram testing to monitor long-term changes in hearing, computed tomography of the head to rule out central lesions and confirm normal inner ear anatomy before surgery, magnetic resonance imaging of the head as needed to rule out posterior fossa lesions causing persistent vertigo, Dix-Hallpike maneuver to diagnose BPPV, PRM and physiotherapy vestibular rehabilitation to attempt treating BPPV before surgical intervention, and sequential transmastoid posterior semicircular canal occlusion for treatment of intractable BPPV. MAIN OUTCOME MEASURES: Postoperative resolution of vertigo induced by head movement and hearing preservation by audiometric testing and postural stability. RESULTS: All patients with severe debilitating bilateral BPPV refractory to medical treatment and PRM had complete resolution of their positional vertigo after bilateral sequential posterior semicircular canal occlusion. Hearing was preserved at the preoperative level in all but 1 patient who developed bilateral postoperative, mild, high-tone sensorineural loss. Residual postoperative adverse effects included transient imbalance in all patients and episodic, nonpositional vertigo in 1 patient. When stressed by extreme head motion, some patients had mild residual instability. There were no other significant long-term complications. CONCLUSION: Bilateral sequential posterior semicircular canal occlusion is a definitive, effective, and safe treatment modality for intractable bilateral BPPV, providing patients with resolution of their vertiginous symptoms. All 6 patients stated that the alleviation of their BPPV symptoms far out-weighed the residual motion sensitivity resulting from the occluded canals.

Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial.

CONTEXT: Idiopathic sudden sensorineural hearing loss has been treated with oral corticosteroids for more than 30 years. Recently, many patients' symptoms have been managed with intratympanic steroid therapy. No satisfactory comparative effectiveness study to support this practice exists. OBJECTIVE: To compare the effectiveness of oral vs intratympanic steroid to treat sudden sensorineural hearing loss. DESIGN, SETTING, AND PATIENTS: Prospective, randomized, noninferiority trial involving 250 patients with unilateral sensorineural hearing loss presenting within 14 days of onset of 50 dB or higher of pure tone average (PTA) hearing threshold. The study was conducted from December 2004 through October 2009 at 16 academic community-based otology practices. Participants were followed up for 6 months. INTERVENTION: One hundred twenty-one patients received either 60 mg/d of oral prednisone for 14 days with a 5-day taper and 129 patients received 4 doses over 14 days of 40 mg/mL of methylprednisolone injected into the middle ear. MAIN OUTCOME MEASURES: Primary end point was change in hearing at 2 months after treatment. Noninferiority was defined as less than a 10-dB difference in hearing outcome between treatments. RESULTS: In the oral prednisone group, PTA improved by 30.7 dB compared with a 28.7-dB improvement in the intratympanic treatment group. Mean pure tone average at 2 months was 56.0 for the oral steroid treatment group and 57.6 dB for the intratympanic treatment group. Recovery of hearing on oral treatment at 2 months by intention-to-treat analysis was 2.0 dB greater than intratympanic treatment (95.21% upper confidence interval, 6.6 dB). Per-protocol analysis confirmed the intention-to-treat result. Thus, the hypothesis of inferiority of intratympanic methylprednisolone to oral prednisone for primary treatment of sudden sensorineural hearing loss was rejected. CONCLUSION: Among patients with idiopathic sudden sensorineural hearing loss, hearing level 2 months after treatment showed that intratympanic treatment was not inferior to oral prednisone treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00097448.

10-year review of endolymphatic sac surgery for intractable meniere disease.

OBJECTIVE: To review our 10-year experience of endolymphatic sac surgery (ESS) for intractable Meniere disease (MD). DESIGN: Retrospective chart review and survey. SETTING: Tertiary care centre. METHODS: Patients presenting for ESS from 1998 to 2007 were reviewed using the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. A quality of life (QOL) questionnaire was mailed out using the Dillman method. MAIN OUTCOME MEASURES: (1) 1995 AAO-HNS hearing stage, vertigo class, and functional level; (2) complications and secondary treatments; (3) a 40-question, disease-specific, validated QOL questionnaire (Meniere's Disease Outcome Questionnaire). RESULTS: Thirty patients (33 ears) had ESS (63.6% male, mean age 49 years, mean follow-up 30.6 months). Vertigo control was 35.5% class A, 29.0% class B, 6.5% class C, 0% class D, 3.2% class E, and 25.8% class F. If class A and B are considered successful, then 64.5% were successful. Hearing stage improved in 14.8%, remained the same in 51.9%, and worsened in 33.3%. Average preoperative functional level was 4.3 and postoperative level was 3.5 (p = .0016). Secondary treatment after ESS was performed in 26%. Three patients (10.0%) had profound sensorineural hearing loss. Twenty-five questionnaire responses (75.8%) were received. There was a significant increase in QOL scores (p = .000001), and 80% had an improvement in QOL scores. CONCLUSIONS: ESS is a surgical option for MD that offers relief from vertigo in selected patients, but patients need to be cautioned about the risk of hearing loss and the requirement for subsequent destructive treatment in a significant proportion of cases.

Sleep apnea, daytime somnolence, and idiopathic dizziness--a novel association.

OBJECTIVES/HYPOTHESIS: To determine if an association exists between sleep apnea, daytime somnolence, and chronic idiopathic dizziness. STUDY DESIGN: Case-control study of new patients presenting to a tertiary neuro-otologic practice. A total of 46 subjects with idiopathic dizziness (ID), 20 positive controls with dizziness (benign paroxysmal positional vertigo [BPV]), and 69 negative controls with hearing loss (HL) but no dizziness were enrolled. METHODS: Participants who were patients diagnosed with the above conditions and who met all other inclusion criteria completed a sleep questionnaire and had a complete physical exam and investigations to establish or exclude a neuro-otologic diagnosis. They were subsequently evaluated for risk of symptomatic sleep disturbance based on the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire, and the Multivariable Apnea Risk Index (MAP). Statistical analysis was carried out using SPSS (SPSS Inc., Chicago, IL). RESULTS: There was no significant demographic difference among the groups in terms of age, sex, body mass index, neck size, alcohol consumption, or smoking. Using a cutoff of both 10 and 12 on the ESS, the ID were more likely to have significant daytime somnolence than the HL group, with a likelihood ratio (LR) of 7.8 for the ESS 12 score (P = .021) and 7.1 for the ESS 10 score (P = .029). Using the MAP score, a statistically significant difference between the ID group and both the BPV group (LR 3.99, P = .046) and the HL group (LR 5.46, P = .019) was found. CONCLUSIONS: This study suggests that a previously undescribed link between idiopathic dizziness, daytime somnolence, and sleep apnea might exist. Prospective investigation is warranted to determine whether treatment of any sleep issues resolves symptoms of idiopathic dizziness.