Optimizing the Workup for Pediatric Vertigo: Does Audiometry Add Value?

Introduction: Pediatric vertigo is most commonly attributed to benign or functional vestibular diagnoses, for which evaluation is guided by clinical history and physical examination, with contemporary guidelines emphasizing targeted testing based on symptom phenotype and risk factors rather than routine ancillary studies. This study aimed to evaluate the clinical relevance and diagnostic yield of audiometric testing in children presenting with vertigo or dizziness and to determine whether audiogram findings meaningfully influence diagnostic assessment or clinical management.

Methods: A retrospective chart review was conducted at a tertiary children’s hospital. Inclusion criteria were pediatric patients presenting with a primary complaint of dizziness or vertigo between 2020-2025, with the results of audiometric testing. The primary outcome includes the proportion of cases in which audiogram results directly changed the leading diagnosis or differential, and the management. Secondary outcomes include association of abnormal audiometry with otologic final diagnoses versus non-otologic diagnoses.

Results: Of the 266 pediatric patients presenting with vertigo or dizziness, 219 (82.3%) underwent same day audiometric evaluation at their initial assessment. The median age of the overall cohort was 13 years (SD ±4.6), and 68.8% were female. Among patients who underwent audiometric testing, only 13 (5.9%) demonstrated an abnormal audiogram at the time of evaluation. Abnormal audiometric findings were significantly associated with a positive otologic history, specifically prior tympanostomy tube placement (OR 5.83, 95% CI:1.57–22.4; p = 0.007). There was no statistically significant difference between patients who underwent audiometric testing and those who did not with respect to formulation of the differential diagnosis or clinical management.

Conclusions: Audiometric testing rarely changes diagnosis or management in otherwise typical pediatric vertigo presentations. A selective, risk-stratified approach may improve value, limit low-yield investigations, and reduce healthcare utilization.