This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.
A 52-year-old man presents with sudden unilateral hearing loss. While watching television the day before, he noted an abrupt decrease in hearing in his left ear. This was associated with a feeling of pressure and fullness in the ear and an intermittent sensation of “buzzing or ringing.” The hearing deficit was confirmed when he tried to use the telephone: the sound he perceived through the affected ear was markedly diminished and distorted. He attempted to clean his ear canal, but this did not help—nor was there any improvement the next morning.
The patient is otherwise healthy. He uses NSAIDs occasionally for musculoskeletal pain. He takes no other medications. He reports that he has had several episodes of mild vertigo in the past 24 hours, roughly concurrent with his ear symptoms.
Vital signs are normal. Examination of the ears reveals a patent left ear canal and a readily visible and normal-appearing tympanic membrane. Cranial nerves II through XII are normal except for significant loss of hearing in the left ear; bedside tests suggest that the hearing loss is sensorineural rather than conduction-related. Extraocular movements are intact, and there is no nystagmus. The remainder of the physical findings, including the results of a detailed neurological examination, are normal.
Results of initial laboratory studies, including a complete blood cell count, biochemistry profile, and measurement of blood glucose and cholesterol levels, are normal.
Which of the following is the most likely diagnosis?
1. Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope. 1976;86:389-398.
2. Rauch SD. Clinical practice. Idiopathic sudden sensorineural hearing loss. N Engl J Med. 2008;359:833-840.
3. Hughes GB, Freedman MA, Haberkamp TJ, Guay ME. Sudden sensorineural hearing loss. Otolaryngol Clin North Am. 1996;29:393-405.
4. Tucci DL, Farmer JC Jr, Kitch RD, Witsell DL. Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir. Otol Neurotol. 2002;23:301-308.
5. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med. 2003;348:1027-1032.