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Sudden Hearing Loss

Tom Boismier boismier at umich.edu
Thu Jun 20 10:50:38 EST 1996

In article <4q4vq8$97r at newsbf02.news.aol.com>, kfelgs at aol.com says...

>Is it possible that surgery on one ear can affect the hearing in the other 

I can't think of a mechanism for this. This situation could be mimicked 
by an underlying systemic process (autoimmune or metabolic), such as 
bilateral Meniere's that happened to develop in one ear before the other, 
which is fairly common (~10% I think) in Meniere's. 

I assume that the mastiodectomy was done to clear an active infection? Given 
no evidence of active infection on the other side, I would suspect that the 
previous surgery is unrelated to current symptoms, and the patient was 
unlucky enough to develop disease in the other ear.

>2) If this patient has Menieres, is there any definitive test other than
>the triad of symptoms including tinnitus, fluctuating loss and vertigo
>used for diagnosis?  Does anyone know about glycerol testing?

I waited a few days for an ENT to weigh in on this one, but no luck... :)

There is no definitive test for Meniere's, it is diagnosed using clinical 
experience taking into account the patient history and symptoms, audiometry, 
and vestibular testing. I haven't seen much glycerol testing lately, though I 
was at a hospital 10+ years ago that did it. It has lost popularity in the US 
over the past decade. It was never considered to be a gold-standard test for 
Meniere's. Alternative diagnoses to consider include "delayed onset vertigo 
following hearing loss" (see Telian, et al, don't have the reference handy); 
several variants of Meniere's, auttoimmune, etc. A description of the pattern 
of vertigo attacks would help immensely (spontaneous vs motion provoked, 
frequency, duration, relationship to diet, time of day/month, other symptoms 
associated with the attack such as fluctuations in tinnitus, fullness or 
hearing, neurologic symptoms, falls, etc.)

There is a body of work which attempts to describe the pattern of nystagmus 
seen throughout a Meniere's attack, ie, when the attack first starts, 
nystagmus beats one way, as it progresses, nystagmus changes direction. While 
the work was done with patient's already diagnosed with Meniere's, it could 
conceivably be used to aid diagnosis. Unfortunately, authors disagree about 
whether nystagmus first beats away from the sick, then changes to beating 
toward the sick ear, or vice versa. This is probably due to the extreme 
difficulty of getting ENG recordings started the instant and attack starts, 
and the general problem with trying to get recordings from someone who is busy 
being very sick.

>3) Does anyone have information on cases of autoimmune hearing loss?  

There is a body of work in peer reviewed journals on this topic. 

>4) Can anyone suggest other forums to present this case for professional
>opinions or where I can access information specific to this case.  Are
>there any ENT consult or organization that would direct me to journals

I would suggest a consult with a neurotologist with an interest in vertigo, 
preferrably at an institution that has a full balance testing lab, with 
computerized ENG, rotational chair, dynamic posturography and a vestibular 
rehabililitation program. (the "balance center" concept that has been in the 
literature lately). Let me know where you are located, and I'll try to come up 
with nearby centers.

>5)Side note.  This patient has reported dizziness following experiences
>with large noisy settings.  What is the tullio effect?  

The Tulio effect is described as brief intense pain and/or vertigo immediately 
following a loud noise burst. Patients who complain of this may also perceive 
vertigo with mild pressure increases in the auditory canal, such as putting a 
finger in the ear.

>6) Looking for cases with hearing loss following spinal manipulation?

No articles that I know of, but vertigo and hearing loss are so common that 
you can frequently find lots of single-case papers associating them with just 
about anything. My patients frequently associate attacks of vertigo with 
flourescent lights, rather than with being in an open area with groups of 
people (or other large objects like trains) moving around them, that just 
happens to have flourescent lights...

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