Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Magnetic resonance imaging of the skull (cranial MRI, cranial MRI, or cMRI) – for suspected:
- Acoustic neuroma (vestibular schwannoma; benign growth of the auditory and vestibular nerves).
- Endolymphhydrops in Meniere’s disease (a disorder of the inner ear associated with rotary vertigo and hypacusis (hearing loss)).
- Vascular nerve contact in vestibular paroxymia.
- Brain tumors
- Cerebellar infarcts (tissue death in the cerebellum as a result of an oxygen deficiency).
- Labyrinth malformation (malformation of the cavity system in the ear).
- Perilymph fistula (connection between the inner ear and middle ear or mastoid (part of the temporal bone, colloquially also called “mastoid process”) with leakage of perilymph).
- Computed tomography of the skull (cranial CT, cranial CT or cCT) – for suspected cholesteatoma (perilymphoma), brain tumors, skull fractures (skull fractures), evidence of vascular-nerve contact in vestibular paroxysmia (neurovascular compression syndrome of the eighth cranial nerve) and the like.
- Computed tomography (CT) of the cervical spine (cervical spine CT) – in suspected cervical spine structural disorders.
- Encephalogram (EEG; recording of the electrical activity of the brain) – if epilepsy is suspected.
- Electronystagmography (ENG, equivalent to electrooculography (EOG; Procedure for measuring the movement of the eyes or changes in the resting potential of the retina) – used to check for disorders of the vestibular system (brain or inner ear) and eye movement system (cerebrum, cerebellum, brainstem) and in cases of vertigo) – in this procedure, an attempt is made to induce nystagmus (involuntary but rapid rhythmic eye movements) with the help of water/air placed in the auditory canal; this is then compared on both sides – eg. For example, if vestibular paroxysm is suspected.
- Tone audiogram (representation of subjective hearing for different tones when a hearing disorder is suspected) – when ENT-associated diseases are suspected.
- Recruitment measurement (representation of objective hearing for different tones).
- Brainstem audiometry (synonym: brainstem evoked response audiometry, BERA); electrophysiological assessment of objective hearing ability – if the measurement results are unambiguous, acoustic neuroma can be largely ruled out.
- Videoculography (VOG); valid and reliable method for the registration of eye movements – measurement of the intensity of a spontaneous nystagmus, performance of caloric testing and in combination with the head impulse test (see below) to quantify the function of the vestibulo-ocular reflex (VOR) in the high frequency range.
- Video-based head impulse test (vKIT): this uses a camera to measure eye movements while the head is rapidly rotated by the examiner and the patient simultaneously tries to keep a target point in view – pathological in cases of labyrinthine failure; for differential diagnosis: vertigo in the inner ear (vestibular vertigo) or in the brain (e.g., apoplexy/stroke)
