Results
Over the period under examination, three adult patient cases were reviewed.
The first patient was a 30-year-old lady who worked as an Audiologist in our hospital. She developed left-sided SSNHL on 5th March 2019, associated with ipsilateral sensation of aural fullness and distorted speech. She had a past medical history of migraines, for which she took prophylactic propranolol. She presented to medical services two days after symptom onset. Otoscopy was unremarkable, and a pure tone audiogram (PTA) showed a low frequency hearing loss in the left ear, on a background of mild bilateral high frequency hearing loss (Figure 1). The high frequency hearing loss had been documented on a PTA a year earlier and was unchanged. She was prescribed a week of oral steroids and subsequent review showed complete recovery (Figure 1). Two months later the patient experienced a recurrence of left-sided SSNHL, which also resolved following a week of oral steroids. In view of the recurrent episodes, further investigations were arranged after symptom resolution. These results were unremarkable, including serum thyroid function, haematology, erythrocyte sedimentation rate, anti-neutrophil cytoplasmic antibody levels, and Lyme disease serology, and normal MRI of the internal auditory meati.
The second patient was a 61-year-old lady who worked as secretarial support for the audiology department. She developed right-sided SSNHL on 13th May 2019 without associated symptoms. She had a past medical history of Type 1 diabetes mellitus. The patient presented to medical services a day after the onset of her symptoms. Otoscopy was normal. PTA showed low frequency sensorineural hearing loss on the right side and normal hearing on the left (Figure 2). The decision was made to proceed with intratympanic rather than oral steroid therapy so that serum glucose control would not be perturbed. Four intratympanic injections were initially scheduled, each 2-3 days apart, but were discontinued after the second injection due to complete symptom resolution and return of hearing to normal (Figure 2). No subsequent investigations took place and there have not been any further symptoms.
The third patient was a 24-year-old man who also worked as secretarial support for the audiology department. He developed right-sided SSNHL a couple in late March 2019. but did not present to clinic until 18th July 2019. He did not seek medical advice at the time of symptom onset, as he attributed his hearing loss to wax accumulation. He had no associated otological symptoms, and there was no past medical, surgical or medication history of note, however his mother had worn bilateral bone-anchored hearing aids. Otoscopy was normal. PTA demonstrated low frequency sensorineural hearing loss on the right side, with normal hearing on the left (Figure 3). In view of his delayed presentation, he was not offered oral steroids but was investigated with MRI, which showed normal internal auditory meati. There has been no resolution of hearing in this patient to date (Figure 3).
There have been no further cases in our audiology department since July 2019.