CLINICAL CASE 7 OF 8

Fluctuating hearing in suspected Ménière's

Vignette

A 47-year-old with episodic vertigo, tinnitus, and aural fullness has a low-frequency sensorineural loss that the patient reports varies between attacks. DPOAEs recorded today are reduced; a recording from a symptom-free period weeks earlier was closer to normal.

Findings

0204060801002505001k2k4k8kFrequency (Hz)
○ Right — PTA 33 dB (Mild)✕ Left — PTA 38 dB (Mild)
Pure-tone audiogram companion. dB HL increases downward, following clinical convention. Illustrative thresholds — not recorded patient data.
-20-1001020DP level (dB SPL)1k1.5k2k3k4k6kf2 frequency (Hz)
● DP emission▮ Noise floor
A normal DP-gram. The emission sits comfortably above the noise floor at every test frequency — the margin between the two is the signal-to-noise ratio. Simplified teaching model, not calibrated normative data.

Diagnostic question

How should the change in DPOAE amplitude between visits be interpreted?

References