No abstract

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.The patient remained well for 1 year, until she experienced an exacerbation of her colitis. One week later, she presented with muffled hearing in her right ear and a sudden onset of rotary vertigo with nausea when she turned to the left. A hearing test showed a moderate to profound sensorineural hearing loss with 80% discrimination in her right ear and a persistent profound sensorineural hearing loss in her left ear. A subsequent T1weighted magnetic resonance imaging scan with gadolinium contrast revealed a new enhancement of the right cochlea and labyrinth. Consistent with the improvement of her left-sided symptoms, the enhancement of the left cochlea and labyrinth was decreased compared with the previous study (Figure 2). The patient was admitted to the hospital and began a regimen of high-dose steroids, carbogen, and antiviral therapy. After she was discharged from the hospital, her steroid therapy was slowly tapered and she began treatment with methotrexate and mercaptopurine. The hearing in her right ear has stabilized. She depends on assistive listening devices.