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Clinical Problem Solving
January 2014

Vertigo and Sudden Hearing Loss at 35 000 Feet

Author Affiliations
  • 1University of Kansas School of Medicine–Wichita, Wichita
  • 2Wesley Medical Center, Wichita, Kansas
  • 3The Wichita Ear Clinic, Wichita, Kansas
JAMA Otolaryngol Head Neck Surg. 2014;140(1):79-80. doi:10.1001/jamaoto.2013.5817

A woman in her 70s presented after experiencing a sudden right-sided hearing loss during descent on a commercial air flight. She reported right-sided tinnitus, otalgia, and vertigo with nausea and vomiting. Her medical history included eustachian tube dysfunction and pressure-induced tympanic membrane perforations; however, she denied a history of vertigo. The Weber test lateralized to the left ear using a 512-Hz tuning fork. Cranial nerves III to VII and IX to XII were normal. The patient was nonambulatory and complained of motion-induced vestibular symptoms. Audiometric test results revealed a right-sided profound mixed hearing loss with severe discrimination impairment, and the left ear had a severe high-frequency hearing loss with normal word discrimination. The right pure-tone average (PTA) was 85 dB and the left was 22 dB. She was treated with a prednisone taper, and a right ventilation tube was placed in anticipation of possible eustachian tube problems with future air travel. Vestibular and balance symptoms improved with vestibular rehabilitation and physical therapy over the next several months. Repeated audiometric tests 1 month after the incident revealed a PTA of 17 dB and 15 dB on the right and left sides, respectively, with normal bilateral word discrimination. Subjective right hearing had returned to its baseline status. Shown herein are a noncontrast computed tomographic (CT) image of the head (Figure, A), CT images of the right temporal bone in the axial plane (Figure, B and C), and a right coronal oblique CT image (Stenver projection) (Figure, D).

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