Medical Excellence - Issue 2

Bilateral Sudden Sensorineural Deafness with Vertigo as the Sole Presenting Symptoms of Diabetes Mellitus - A Case Report Vilas Misra, C. G. Agarwal, Naresh Bhatia, G. K. Shukla Case History A 55-year-old engineer was admitted to CSJMM University, up- graded KGMUniversity, Lucknow, as an emergency with sudden loss of hearing in both ears with vertigo and tinnitus. He noticed a very brief sound in his right ear lasting about a second. He then became completely deaf in both ears and complained of vertigo and high pitched tinnitus. There was no history of facial weak- ness or discharge from his ears. There was no history of exter- nal trauma or sudden straining prior to the onset. There was no history suggestive of a viral infection. There was no family history of deafness. He was a known late diabetic and a hyper- tensive. There was no other significant past medical history. He was not on any regular medication and described himself as per- fectly healthy prior to admission. The hearing in both his ears was known to be normal 12 months before this recent episode. General physical examination revealed no abnormality in any system. Cardiovascular in central nervous system were normal. ENT examination was normal apart from tuning fork tests which indicated a sensorineural hearing loss in both ears. Hematological investigations including total blood count, ESR, urea and electrolytes, blood glycosylated HbA 1C and serology for syphilis were done. An audiogram revealed a 110 dB sensorineu- ral hearing loss at 4 KHz. A 55 dB sensorineural hearing loss at 2 KHz and a 45 dB sensorineural hearing loss at 1 KHz in the left ear. It also revealed a 65 dB sensorineural hearing loss at 4 KHz. A 70 dB sensorineural hearing loss at 2 KHz and a 50 dB sensori- neural hearing loss at 1 KHz in the right ear. Test for recruitment and tone decay indicated a cochlear loss. Blood glycosylated Hb was 12% without ketonuria. The other investigations mentioned above were with in normal limits. The patient was put on insulin drip and anti-hypertensive treatment was begun. Eight days later there was impairment showing deterioration of hearing in the right ear and mild improvement of hearing in the left ear (Figs. 1 and 2). Vestibular tests revealed left beating spontaneous nystag- mus present. On performing Binaural Bithermal Caloric test – Cawthorne Hallpike Fitzgerald test: Left beating nystagmus was present. Abnormal canal paresis was found.  CP (n) = + 17% (right)  CP (d) = + 17% (right) Abnormal directional preponderance was found.  DP = + 30% (right) On performing Unterberger’s test cranio corporography angular rotation = 110° right, was extrapolated. Angular devia- tion = 80° right was extrapolated. Significant right sway was seen on performing Babinski’s heel to toe stepping test. Audio vestibu- lar tests therefore suggest a hemorrhagic labyrinthopathy in the V. Misra 1 , C. G. Agarwal 2 , N. Bhatia 1 , G. K. Shukla 1 1 Department of ENT, 2 Department of Medicine, CSJM Medical University, KG Medical University, Lucknow, India V. Misra (  ) E-mail: vilas_misra@yahoo.com This paper reports a late uncontrolled diabetic presenting to an otolaryngologist with sudden severe sensorineural hearing loss of immediate origin with vertigo and tinnitus as the symptoms. Appropriate investigative and treatment measure resulted in deterioration of hearing in the right ear and mild improvement of hearing in the left ear, with no recovery of imbalance. Keywords: Sudden severe sensorineural hearing loss, Vertigo, Tinnitus, Diabetes mellitus (NIDDM) Issue-2  |  9 MEDICAL EXCELLENCE