ABSTRACT

Background: Idiopathic Intracranial Hypertension (IIH) is characterized by increased intracranial pressure (ICP) without a clear etiology. Up to 50% of patients report audiovestibular symptoms, such as pulsatile tinnitus and dizziness, yet few studies have assessed the objective impact on auditory and vestibular systems. Objective: to evaluate the effect of elevated ICP on auditory and vestibular function in patients with IIH using audiological and neuro-otological test batteries. Methods: This case-control study included 25 adult females with IIH and 25 age-matched healthy female controls. Participants underwent comprehensive auditory evaluation (pure tone audiometry, speech audiometry, tympanometry), cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), and videonystagmography (VNG). Results: Significant differences were observed between groups in pure tone thresholds (250–8000 Hz) and speech recognition thresholds. cVEMP showed prolonged P13 and N23 latencies and reduced amplitudes; responses at 500 Hz were absent in 9 ears. oVEMP results revealed absent responses in 10 ears, delayed P15 latency, and reduced N10–P15 amplitudes. VNG revealed spontaneous nystagmus (24%), oculomotor test abnormalities (20%), and caloric weakness (32%). Positional testing identified BPPV in 5 cases. Audiovestibular symptoms included dizziness (44%), pulsatile tinnitus (40%), and ear fullness (28%). Conclusions: IIH significantly affects both auditory and vestibular systems, often subclinically. Auditory involvement is reflected in pure tone thresholds, while vestibular impairment includes both peripheral and central features, evidenced by VEMP and VNG abnormalities. Audiovestibular testing should be routinely considered in IIH management.