Which statement best differentiates conditions with cochlear involvement from vestibular pathology without cochlear involvement?

• A. Hearing loss with tinnitus indicates labyrinthitis; intact hearing indicates vestibular neuritis.
• B. Absence of vertigo indicates vestibular pathology.
• C. Visual disturbance is required.
• D. It always resolves in 24 hours.

Answer: (A)

The main idea is using hearing status to separate cochlear involvement from vestibular-only problems. The cochlea handles hearing, so when it’s affected you often see hearing loss and may notice tinnitus. If the issue is limited to the vestibular system, hearing stays normal.

Labyrinthitis involves inflammation of both cochlear and vestibular structures, producing vertigo with hearing loss and tinnitus. Vestibular neuritis, on the other hand, affects the vestibular nerve but spares the cochlea, so vertigo occurs with intact hearing.

Therefore, hearing loss with tinnitus points to labyrinthitis (cochlear involvement), while intact hearing points to vestibular neuritis (no cochlear involvement). Other statements don’t reliably differentiate these conditions because vertigo can be present in both, visual symptoms aren’t required, and the duration can vary.