Learning Objectives: 1. Understand the causes of vestibular dysfunction in chronic ear disease. 2. Appreciate the available vestibular function tests to assess function in the setting of middle ear/mastoid disease. 3. Recognize the causes, symptoms and treatment for labyrinthine fistulae and third window phenomena.

Patients with chronic ear disease and cholesteatoma frequently present with symptoms of dizziness and vertigo that may represent labyrinthine dysfunction in the involved ear or dizziness from unrelated causes. The challenge for the otologist is to recognize specific signs of vestibular involvement on the physical exam and order appropriate vestibular function testing. This panel will explore various examination and laboratory signs of labyrinthine involvement in patients presenting with dizziness. Of particular interest on examination are the presence of the Halmagyi head impulse sign, presence of nystagmus with pressure or air caloric stimulation, and the postural responses on foam posturography. In the laboratory, responses to rotation, centrifugation, evoked responses to sound stimulation and computerized dynamic posturography are of particular utility to diagnose and treat labyrinthine dysfunction in patients with active chronic ear disease.