ABSTRACT
I. The history is variable. The deafness may be sudden in onset and practically complete in one ear, as may occur in fracture of the skull involving the internal auditory meatus; or it may be gradual and bilateral, as in progressive hereditary nerve deafness. It may follow many other patterns, as well. A history of familial deafness often is helpful, but it should be borne in mind that a family history of hearing loss also is to be expected in otosclerosis. The patient's age is of little help, because nerve deafness may occur in any age group. Vertigo is an important symptom. If it is present, especially in the presence of a unilateral sensory hearing loss, its cause must be established: at least the presence of an acoustic nerve tumor (acoustic neuroma) must be ruled out. Tinnitus does not aid the differential diagnosis of nerve deafness per se; but if present, it is likely to be high-pitched.
