Tullio phenomenon, sound-induced vertigo, dizziness, nausea or eye movement (nystagmus) was first described in 1929 by the Italian biologist Prof. Pietro Tullio. (1881–1941) During his experiments on pigeons, Tullio discovered that by drilling tiny holes in the semicircular canals of his subjects, he could subsequently cause them balance problems when exposed to sound.

The cause is usually a fistula in the middle or inner ear, allowing abnormal sound-synchronized pressure changes in the balance organs. Such an opening may be caused by a barotrauma (e.g. incurred when diving or flying), or may be a side effect of fenestration surgery, syphilis or Lyme disease.

Patients with this disorder may also experience vertigo, imbalance and eye movement set off by changes in pressure, e.g. when nose-blowing, swallowing or when lifting heavy objects.

Tullio phenomenon is also one of the common symptoms of superior canal dehiscence syndrome (SCDS), first diagnosed in 1998 by Dr. Lloyd B. Minor, The Johns Hopkins University, Baltimore, United States.

Many patients will report a history of vertigo as a result of fast head movements. Many patients are also capable of describing the exact head movements that provoke their vertigo. Purely horizontal nystagmus and symptoms of vertigo lasting more than one minute can also indicate BPPV occurring in the horizontal semicircular canal.

Patients do not experience other neurological deficits such as numbness or weakness, and if these symptoms are present, a more serious etiology, such as posterior circulation stroke or ischemia, must be considered.

The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes. The most common movements patients report triggering a spinning sensation are tilting their heads upwards in order to look at something, and rolling over in bed.

Labyrinthitis presents with severe vertigo with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear though several theories have been put forward and the cause remains uncertain. Individuals with vestibular neuritis do not typically have auditory symptoms but may experience a sensation of aural fullness or tinnitus. Persisting balance problems may remain in 30% of people affected.

Vertigo is a sensation of spinning while stationary. It is commonly associated with nausea or vomiting, unsteadiness (postural instability), falls, changes to a person's thoughts, and difficulties in walking. Recurrent episodes in those with vertigo are common and frequently impair the quality of life. Blurred vision, difficulty in speaking, a lowered level of consciousness, and hearing loss may also occur. The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset.

Persistent onset vertigo is characterized by symptoms lasting for longer than one day and is caused by degenerative changes that affect balance as people age. Naturally, the nerve conduction slows with aging and a decreased vibratory sensation is common.

Additionally, there is a degeneration of the ampulla and otolith organs with an increase in age. Persistent onset is commonly paired with central vertigo signs and symptoms.

The characteristics of an episodic onset vertigo is indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes. Typically, episodic vertigo is correlated with peripheral symptoms and can be the result of but not limited to diabetic neuropathy or autoimmune disease.

Superior canal (SCD) can affect both hearing and balance to different extents in different people.

Symptoms of SCDS include:

- Autophony – person's own speech or other self-generated noises (e.g. heartbeat, eye movements, creaking joints, chewing) are heard unusually loudly in the affected ear

- Dizziness/ vertigo/ chronic disequilibrium caused by the dysfunction of the superior semicircular canal

- Tullio phenomenon – sound-induced vertigo, disequilibrium or dizziness, nystagmus and oscillopsia

- Pulse-synchronous oscillopsia

- Hyperacusis – the over-sensitivity to sound

- Low-frequency conductive hearing loss

- A feeling of fullness in the affected ear

- Pulsatile tinnitus

- Brain fog

- Fatigue

- Headache/migraine

- Tinnitus – high pitched ringing in the ear

Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, that is, of a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute. Nausea is commonly associated. BPPV is one of the most common causes of vertigo.

BPPV can result from a head injury or simply occur among those who are older. A specific cause is often not found. The underlying mechanism involves a small calcified otolith moving around loose in the inner ear. It is a type of balance disorder along with labyrinthitis and Ménière's disease. Diagnosis is typically made when the Dix–Hallpike test results in nystagmus (a specific movement pattern of the eyes) and other possible causes have been ruled out. In typical cases medical imaging is not needed.

BPPV is often treated with a number of simple movements such as the Epley maneuver or Brandt–Daroff exercises. Medications may be used to help with nausea. There is tentative evidence that betahistine may help with the vertigo but its use is not generally needed. BPPV is not a serious condition. Typically it resolves in one to two weeks. It however may recur in some people.

The first medical description of the condition occurred in 1921 by Robert Barany. About 2.4% of people are affected at some point in time. Among those who live until their 80s, 10% have been affected. BPPV affects females twice as often as males. Onset is typically in the person's 50s to 70s.

In hyperacusis, the symptoms are ear pain, annoyance, and general intolerance to many sounds that most people are unaffected by. Crying spells or panic attacks may result from the experience of hyperacusis. It may affect either or both ears. Hyperacusis can also be accompanied by tinnitus. Hyperacusis can result in anxiety, stress and phonophobia. Avoidant behaviour is often a response to prevent the effects of hyperacusis and this can include avoiding social situations.

Signs and symptoms of AIED are:

- Progressive hearing loss in both ears

- Typically will begin in one ear and gradually affect the other

- Hearing loss may begin suddenly

- Tinnitus (ringing or buzzing in ears)

- Decrease in word recognition capability

- Loss of balance (vestibular symptoms)

- Degree of balance loss can change throughout the course of the disease

Hyperacusis (or hyperacousis) is a debilitating hearing disorder characterized by an increased sensitivity to certain frequencies and volume ranges of sound (a collapsed tolerance to usual environmental sound). A person with severe hyperacusis has difficulty tolerating everyday sounds, some of which may seem unpleasantly or painfully loud to that person but not to others.

"Hyperacusis" is often coincident with tinnitus. Both conditions have a prevalence of about 10–15% and hearing loss as a major risk factor. However, there also appear to be important differences between the mechanisms involved in tinnitus and hyperacusis.

Superior canal dehiscence syndrome (SCDS) is a set of hearing and balance symptoms, related to a rare medical condition of the inner ear, known as "superior canal dehiscence". The symptoms are caused by a thinning or complete absence of the part of the temporal bone overlying the superior semicircular canal of the vestibular system. There is evidence that this rare defect, or susceptibility, is congenital. There are also numerous cases of symptoms arising after physical trauma to the head. It was first described in 1998 by Lloyd B. Minor of Johns Hopkins University in Baltimore.

Due to variations in study designs, data on the course of tinnitus showed few consistent results. Generally the prevalence increased with age in adults, whereas the ratings of annoyance decreased with duration.

Persistent tinnitus may cause anxiety and depression. Tinnitus annoyance is more strongly associated with psychological condition than loudness or frequency range. Psychological problems such as depression, anxiety, sleep disturbances and concentration difficulties are common in those with strongly annoying tinnitus. 45% of people with tinnitus have an anxiety disorder at some time in their life.

Psychological research has looked at the tinnitus distress reaction (TDR) to account for differences in tinnitus severity. These findings suggest that at the initial perception of tinnitus, conditioning links tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.

Alexanders law refers to spontaneous nystagmus that occurs after an acute unilateral vestibular loss. It was first described in 1912 and has three elements to explain how the vestibulo-ocular reflex responds to an acute vestibular insult. The first element says that spontaneous nystagmus after an acute vestibular impairment has the fast phase directed toward the healthy ear. The direction of the nystagmus, by convention, is named for the fast phase, so the spontaneous nystagmus is directed toward the healthy ear. The second element says nystagmus is greatest when gaze is directed toward the healthy ear, is attentuated at central gaze and may be absent when gaze is directed toward the impaired ear. The third element says that spontaneous nystagmus with central gaze is augmented when vision is denied. This became apparent with the implementation of electrographic testing.

Alexander's law states that in individuals with nystagmus, the amplitude of the nystagmus increases when the eye moves in the direction of the fast phase (saccade).

It is manifested during spontaneous nystagmus in a patient with a vestibular lesion. The nystagmus becomes more intense when the patient looks in the quick-phase than in the slow-phase direction.

The law was named after Gustav Alexander who described it in 1912.

Dysacusis is a hearing impairment characterized by difficulty in processing details of sound due to distortion in frequency or intensity, but not primarily a loss of the ability to perceive sound. The term is sometimes used to describe pain or discomfort due to sound, a condition also known as auditory dysesthesia.

There are a few cases of palinopsia with many of the same features as hallucinatory palinopsia (formed image perseveration) but with some important differences. The formed perseverated image may only last a couple seconds or may be black or translucent. These variants usually lack the realistic clarity of hallucinatory palinopsia, and the generation of the palinoptic images is affected by fixation time, motion, stimulus intensity, or contrast. These variants probably represent an overlap in hallucinatory and illusory palinopsia but are included in illusory palinopsia since they often co-exist with the other illusory symptoms.

Visual trailing describes an object in motion leaving frozen copies in its wake. These motion-induced afterimages may be discontinuous such as in a film reel or may be blurred together such as in a long-exposure photograph. If discontinuous, the patient also usually reports akinetopsia. The perseverated images last a few seconds and are usually identical in color and shape to the original stimulus. Most cases describe visual trails during movement of an object, although there are also reports from the movement of the observer's head or eyes.

Auditory fatigue is defined as a temporary loss of hearing after exposure to sound. This results in a temporary shift of the auditory threshold known as a "temporary threshold shift" (TTS). The damage can become permanent (permanent threshold shift, PTS) if sufficient recovery time is not allowed for before continued sound exposure. When the hearing loss is rooted from a traumatic occurrence, it may be classified as noise-induced hearing loss, or NIHL.

There are two main types of auditory fatigue, short-term and long-term. These are distinguished from each other by several characteristics listed individually below.

Short-term fatigue

- full recovery from TTS can be achieved in approximately two minutes

- the TTS is relatively independent of exposure duration

- TTS is maximal at the exposure frequency of the sound

Long-term fatigue

- recovery requires a minimum of several minutes but can take up to several days

- dependent on exposure duration and noise level

SSHL is diagnosed via pure tone audiometry. If the test shows a loss of at least 30db in three adjacent frequencies, the hearing loss is diagnosed as SSHL. For example, a hearing loss of 30db would make conversational speech sound more like a whisper.

Bruns nystagmus is an unusual type of bilateral nystagmus most commonly occurring in patients with cerebellopontine angle tumours. It is caused by the combination of slow, large amplitude nystagmus (gaze paretic nystagmus) when looking towards the side of the lesion, and rapid, small amplitude nystagmus (vestibular nystagmus) when looking away from the side of the lesion. It occurs in 11% of patients with vestibular schwannoma, and occurs mainly in patients with larger tumours (67% of patients with tumours over 3.5 cm diameter). Bruns nystagmus is also associated with an increased incidence of balance disturbance in patients with vestibular schwannoma. It may be caused by the compression of both flocculi, the vestibular part of the cerebellum, and improvement in both the nystagmus and balance problems occur commonly after removal of the tumour.

Bruns nystagmus is named for Ludwig Bruns (1858 – 1915).

White dog shaker syndrome (also known as idiopathic steroid responsive shaker syndrome, shaker dog syndrome and "little white shakers" syndrome; Latin name Idiopathic Cerebellitis) causes full body tremors in small dog breeds. It is most common in West Highland White Terriers, Maltese, Bichons, and Poodles, and other small dogs. There is a sudden onset of the disease at one to two years of age. It is more likely to occur, and the symptom is worse during times of stress. Nystagmus, difficulty walking, and seizures may occur in some dogs.

The cause is unknown, but it may be mediated by the immune system. One theory is that there is an autoimmune-induced generalized deficiency of neurotransmitters. Cerebrospinal fluid analysis may reveal an increased number of lymphocytes. Treatment with corticosteroids may put the dog into remission, or diazepam may control the symptoms. Typically the two drugs are used together. There is a good prognosis, and symptoms usually resolve with treatment within a week, although lifelong treatment may be necessary.

Many people notice that they have SSHL when they wake up in the morning. Others first notice it when they try to use the deafened ear, such as when they use a phone. Still others notice a loud, alarming "pop" just before their hearing disappears. People with sudden deafness often become dizzy, have ringing in their ears (tinnitus), or both.

Motion sickness is a condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement. Depending on the cause, it can also be referred to as seasickness, car sickness, simulation sickness or airsickness.

Dizziness, fatigue and nausea are the most common symptoms of motion sickness. Sopite syndrome, in which a person feels fatigue or tiredness, is also associated with motion sickness. "Nausea" in Greek means seasickness ("naus" means ship). If the motion causing nausea is not resolved, the sufferer will usually vomit. Vomiting often will not relieve the feeling of weakness and nausea, which means the person might continue to vomit until the cause of the nausea is treated.

Primary symptoms:

- sounds or speech becoming dull, muffled or attenuated

- need for increased volume on television, radio, music and other audio sources

- difficulty using the telephone

- loss of directionality of sound

- difficulty understanding speech, especially women and children

- difficulty in speech discrimination against background noise (cocktail party effect)

Secondary symptoms:

- hyperacusis, heightened sensitivity to certain volumes and frequencies of sound, resulting from "recruitment"

- tinnitus, ringing, buzzing, hissing or other sounds in the ear when no external sound is present

- vertigo and disequilibrium

Usually occurs after age 50, but deterioration in hearing has been found to start very early, from about the age of 18 years. The ISO standard 7029 shows expected threshold changes due purely to age for carefully screened populations (i.e. excluding those with ear disease, noise exposure etc.), based on a meta-analysis of published data. Age affects high frequencies more than low, and men more than women. One early consequence is that even young adults may lose the ability to hear very high frequency tones above 15 or 16 kHz. Despite this, age-related hearing loss may only become noticeable later in life. The effects of age can be exacerbated by exposure to environmental noise, whether at work or in leisure time (shooting, music, etc.). This is noise-induced hearing loss (NIHL) and is distinct from presbycusis. A second exacerbating factor is exposure to ototoxic drugs and chemicals.

Over time, the detection of high-pitched sounds becomes more difficult, and speech perception is affected, particularly of sibilants and fricatives. Patients typically express a decreased ability to understand speech. Once the loss has progressed to the 2-4kHz range, there is increased difficulty understanding consonants. Both ears tend to be affected. The impact of presbycusis on communication depends on both the severity of the condition and the communication partner.

Parinaud's Syndrome is a cluster of abnormalities of eye movement and pupil dysfunction, characterized by:

1. Paralysis of upgaze: Downward gaze is usually preserved. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail.

2. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation.

3. Convergence-Retraction nystagmus: Attempts at upward gaze often produce this phenomenon. On fast up-gaze, the eyes pull in and the globes retract. The easiest way to bring out this reaction is to ask the patient to follow down-going stripes on an optokinetic drum.

4. Eyelid retraction (Collier's sign)

5. Conjugate down gaze in the primary position: "setting-sun sign". Neurosurgeons see this sign most commonly in patients with failed hydrocephalus shunts.

It is also commonly associated with bilateral papilledema. It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia.

Since AIED symptoms are fairly common to many hearing loss disorders, it may be difficult to diagnose AIED without performing multiple medical tests. Some examples of these tests include:

- Hearing Tests for Progressive Hearing and Balance loss

- Audiometry (measure of hearing acuity and sound intensity)

- Rotatory Chair Test (determines if inner ear is responsible for balance loss)

- Electrocochleography (ECOG) (recording of electrical potential in inner ear due to sound)

- Blood Tests for General Autoimmune Diseases

- Erythrocyte sedimentation rate (test for inflammation)

- Rheumatoid Factor (indicator of autoimmune disorders)

There are also blood tests specific to inner ear disorders:

- Anti-cochlear antibody test (testing for antibodies against cochlear cells)

- Lymphocyte Transformation Assay (testing whether an individual has developed a T-cell response against a certain drug)

Though it has also been proposed that the use of anti heat shock protein 70 antibodies may be useful in the detection and diagnosis of AIED, there is not enough evidence to confirm the reliability of this method.