ENG in a dizzy patient with binaural hearing loss following surgery for Meniere's syndrome.A 20-year-old woman came to the office with a 6-year history of Meniere's syndrome. Her condition had come on suddenly; her symptoms had been preceded by the onset of tinnitus in both ears, which was followed by violent rotary vertigo with nausea and vomiting Nausea and Vomiting Definition Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling of undigested food through the mouth. . During each recurrence, these spells would last from 20 minutes to 2 hours. She had undergone placement of a right endolymphatic endolymphatic pertaining to or emanating from the endolymph. endolymphatic duct connects the saccule of the membranous labyrinth of the internal ear to the endolymphatic sac. mastoid mastoid /mas·toid/ (mas´toid) 1. breast-shaped. 2. mastoid process. 3. pertaining to the mastoid process. mas·toid n. The mastoid process. shunt, but she noticed no change in her dizziness postoperatively. At her visit to the author's office, the patient reported no significant dizziness. She was taking cortisone cortisone (kôr`tĭsōn'), steroid hormone whose main physiological effect is on carbohydrate metabolism. It is synthesized from cholesterol in the outer layer, or cortex, of the adrenal gland under the stimulation of adrenocorticotropic , a diuretic, and a nausea suppressant, which were controlling this symptom. She still experienced some hearing loss in both ears, more so on the right. Beginning 6 years earlier, her hearing had progressively deteriorated until she underwent the mastoid shunt surgery. Thereafter, the quality of her hearing fluctuated and had remained fluctuant until 3 months prior to her office visit. It had been stable since. The patient's primary concern was the preservation of her hearing. Her tinnitus in the left ear had resolved, but it was still present in the right ear. It had been constant for the preceding 3 months. She reported aural fullness in both ears (more so on the right) upon the onset of dizziness. On clinical examination, the patient experienced difficulty performing the sharpened tandem Romberg's test. Her family history was negative for hearing loss and dizziness. Electronystagmography in the absence of medications revealed no spontaneous, positional, or neck-torsion nystagmus Nystagmus Definition Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generally involuntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often, but not necessarily, a sign of . The alternate binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears. bin·au·ral adj. Having or relating to both ears. binaural pertaining to both ears. bithermal test elicited a hypoactive (and sometimes absent) response to the cool stimulus on the right and no response to the warm stimulus in either ear (a reduced vestibular response of 66 to 100% right and a directional preponderance of 66 to 100% right). Ice-water calorics in the right ear elicited a normal response, which represented a form of vestibular recruitment and suggested that the source of the dizziness was the labyrinth. The simultaneous binaural bithermal test elicited a type 1 response--that is, no nystagmus was produced with either the warm or cool simultaneous stimulus. Audiometry identified a bilateral sensorineural hearing loss Sensorineural hearing loss Hearing loss caused by damage to the nerves or parts of the inner ear governing the sense of hearing. Mentioned in: Tinnitus sensorineural hearing loss . The loss was moderately fiat in the left ear. The right ear exhibited a moderate to severe loss of low-tone hearing and a moderate loss of middle-and high-tone hearing. Further testing revealed that the patient had a 50-dB speech reception threshold (SRT) and an 84% speech discrimination score (SDS) in the right ear, and a 30-dB SRT and a 92% SDS in the left ear. The vestibular findings in this case are consistent with a bilateral peripheral vestibular disorder peripheral vestibular disorder Neurology A hallucination of movement, either subjective or objective History Duration of an attack–eg, hrs v. days, frequency daily v. . However, these findings might also be explained by the fact that stimulation of the efferents from the right ear suppressed or inhibited the auditory and vestibular hair cell function in the apparently unaffected left inner ear. From Neurotologic Associates, P.C., New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . |
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