R. NICKBRYANMDS. JAMESZINREICHMD
A 52-YEAR-OLD woman presented with vertigo, nausea, vomiting, and left-sided hearing loss that had developed after a sinus infection. Her medical history was significant for Samter triad, ulcerative colitis, arthritis, and osteoporosis. Her medications at the time were albuterol, salmeterol xinafoate, fluticasone, mesalamine, metronidazole, and levofloxacin.
An otologic examination showed intact and mobile tympanic membranes. A tuning fork examination at 512 Hz revealed lateralizing to the right on the Weber test and a positive Rinne test result in the right ear. There was no response to the tuning fork tests in the left ear. An ocular examination demonstrated no spontaneous or evoked nystagmus, and extraocular movements were intact. The results of the rest of the head and neck examination were normal. A neurologic examination was significant for a widened gait. On Romberg and tandem Romberg testing, the patient fell to the left. Audiometric evaluation showed a profound left sensorineural hearing loss. A T1-weighted magnetic resonance imaging scan with gadolinium contrast revealed enhancement involving the left cochlea and labyrinth (Figure 1). Prednisone and nizatidine therapy was initiated. The patient's symptoms, other than her hearing loss, resolved.
Smith JL, Goldstein SA, Willcox TO. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2002;128(1):80. doi:10.1001/archotol.128.1.80
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