The ear is not only for hearing. The inner ear also contains the organs of balance, the vestibular system. This is why pain, discharge, hearing loss, ringing, vertigo and unsteadiness should be assessed together, starting with a complete ENT consultation.
During the consultation Dr Puya Dehgani-Mobaraki examines the ear canal and eardrum with endoscopic instruments, as for all ENT areas. When needed, audiometric and vestibular tests are carried out at all the venues where he sees patients.
Where to start: your symptom
- Ear infections (otitis): ear pain, discharge, a “blocked” ear after a cold (in Italian).
- Hearing loss: hearing less, on one or both sides, suddenly or gradually (in Italian).
- Positional vertigo (BPPV): brief, intense vertigo when turning over in bed, getting up or looking up.
- Vestibular deficits: persistent unsteadiness, after acute vertigo or without an obvious cause (in Italian).
- Otosclerosis: progressive hearing loss, often in young adults, sometimes with tinnitus (in Italian).
- Tumours of the ear and vestibular nerve: one-sided hearing loss or tinnitus, lesions of the outer ear or ear canal (in Italian).
When not to wait
Contact a doctor or the Emergency Department promptly if any of these signs appear:
- sudden hearing loss, especially on one side: it needs a prompt ENT assessment, ideally within the first few days;
- vertigo with difficulty speaking, double vision, weakness or tingling in the arms or legs, difficulty walking, or a severe and unusual headache;
- an ear infection with high fever, swelling or redness behind the ear, facial paralysis or severe vertigo.
How the assessment works
- History: how the symptoms started, how long they last, what triggers them.
- ENT examination with endoscopic assessment of the ear, nose and nasopharynx, because many middle ear problems depend on the Eustachian tube.
- Audiometric and vestibular tests when indicated, available at all venues.
- Next steps: medical treatment, repositioning manoeuvres, vestibular rehabilitation, hearing aids, or referral for imaging or to specialist centres when necessary.
Tinnitus
Tinnitus is the perception of a sound, such as whistling, buzzing or hissing, with no external source. It is very common and often accompanies hearing loss, even mild.
The ENT consultation and audiometry help to assess it. Tinnitus that is one-sided, pulsatile (beating with the heart) or associated with asymmetric or sudden hearing loss requires targeted assessment.
The available evidence does not support routine use of drugs or supplements for tinnitus. The strategies with the strongest evidence are cognitive behavioural therapy, hearing aids when there is hearing loss, and appropriate counselling.
Ménière’s disease
Ménière’s disease presents with spontaneous, recurrent attacks of vertigo lasting from about 20 minutes to 12 hours. In the same ear there are fluctuating symptoms: hearing, tinnitus and a sense of fullness.
A diagnosis of “definite” Ménière’s disease requires at least two such attacks and sensorineural hearing loss documented by audiometry at low and medium frequencies, after other causes have been excluded. Treatment is chosen according to the frequency and severity of the attacks and includes lifestyle changes, medical treatment and, in resistant cases, intratympanic therapy.
Research
Dr Dehgani-Mobaraki has taken part in studies on benign paroxysmal positional vertigo:
- a review of residual dizziness, the unsteadiness that can persist after a successful manoeuvre;
- a study on the reliability of a history questionnaire for diagnosing BPPV in older people.
Details are on the BPPV page.
Read more: Venues and booking · How the consultation works · Hyperbaric oxygen therapy in sudden hearing loss (in Italian)
📋 Tinnitus, vertigo and Eustachian tube problems are measured with validated questionnaires such as the THI, DHI and ETDQ-7: they are explained on the page Questionnaires and rating scales (in Italian).
Key references
- Tunkel DE et al. Clinical Practice Guideline: Tinnitus. Otolaryngol Head Neck Surg 2014. DOI 10.1177/0194599814545325
- Lopez-Escamez JA et al. Diagnostic criteria for Ménière’s disease (Bárány Society). J Vestib Res 2015. DOI 10.3233/VES-150549
- Basura GJ et al. Clinical Practice Guideline: Ménière’s Disease. Otolaryngol Head Neck Surg 2020;162(2_suppl):S1-S55. PubMed
Author: Dr Puya Dehgani-Mobaraki, specialist in Otorhinolaryngology and Head and Neck Surgery. Last clinical review: October 2026. The information is for general education and does not replace a medical diagnosis or prescription.