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March 2015

When the Music Stops, Choose Your Options Wisely: A Teachable Moment

Author Affiliations
  • 1Department of Hematology and Medical Oncology, Oregon Health and Science University, Portland
  • 2Division of General Internal Medicine, Department of Medicine, University of Colorado, Denver
JAMA Intern Med. 2015;175(3):341-342. doi:10.1001/jamainternmed.2014.6566

A man in his 70s with hypertension and type 2 diabetes mellitus presented to the clinic complaining of 6 days of sudden-onset, right-sided hearing loss. He reported hearing a phone ring, holding the phone to his right ear, and being unable to appreciate any sound. His left-sided hearing was unaffected. He stated that he had not had any recent upper respiratory infection, trauma, headache, slurred speech, weakness, facial droop, otalgia, imbalance, or tinnitus. On examination he had normal blood pressure, clear external auditory canals, and normal tympanic membranes. Findings from the neurologic examination were normal except for pronounced right-sided hearing loss. The otolaryngology service was consulted, but they were unable to perform an immediate in-person evaluation in the clinic. Instead, they recommended an urgent, noncontrast computed tomographic (CT) scan of the head as well as an audiologic examination. The results of the CT scan were normal. Same-day pure-tone audiometry demonstrated normal hearing in the patient’s left ear, and findings were consistent with sensorineural hearing loss (SNHL) in the right ear. Following current treatment guidelines, he was prescribed prednisone, 60 mg daily for 7 days. Within 1 week, his right-sided hearing had returned almost to baseline, and repeated audiologic testing 2 weeks later showed complete resolution.

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