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Clinical Problem Solving: Radiology
June 2005

Radiology Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(6):534. doi:10.1001/archotol.131.6.534

A 4-year-old Hispanic girl presented with a 3-week history of acute subjective hearing loss. She had no history of recurrent otitis media, trauma, jaundice, or meningitis, but she had developed bilateral knee and hip swelling approximately 2 months earlier. She underwent aspiration of her knee effusion as well as a full rheumatologic workup, and the working diagnosis of juvenile rheumatoid arthritis was made. Her medical history was significant for a history of prematurity, for which she had spent 1 week in the neonatal intensive care unit, where she received nutritional supplementation but no antibiotics or other medications. She had normal developmental milestones, and her immunizations were up to date. She was taking no medications and had no known allergies. Her family history was negative for hearing loss, and she had not traveled outside the United States. Her physical examination was significant for mildly retracted tympanic membranes and left scleral injection. Her neurologic examination was nonfocal. Her initial audiogram revealed profound bilateral sensorineural hearing loss (SNHL). Prednisone therapy was initiated at a dosage of 1 mg/kg per day. An audiogram obtained approximately 1 week later revealed worsening hearing. The prednisone therapy was discontinued.

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