Relapsing Sudden Deafness with Benign Paroxysmal Positional Vertigo
Jiann-Jy Chen, Dem-Lion Chen.
We describe a 44-year-old woman who had right tinnitus up to six times in recent seven years. Right reversible sensory hearing loss was identified, but vertigo did not attribute to canulolithesis of semicircular canal. Although it is yet beyond the current image techniques and equipment to solve the enigma in such a case, we suggest an unknown recurrent vasculopathy, rather than Ménière's disease or migrainous vertigo acted on the underlying presumably abnormal microcirculation of the inner ear and left behind the right transient cochleopathy with partial vestibulopathy. (Rawal Med J 2010;35: ).
Key words: sudden deafness, cochleopathy, vestibulopathy, benign paroxysmal positional vertigo, Ménière's disease, migrainous vertigo.
Sudden deafness is defined as hearing losses up to 30dB hearing level (dBHL) over three continuing audiogram frequencies within three days. Unilateral sufferers are much more than bilateral ones. It is prevalent in adult Taiwanese between 40 and 60 years old, with the average of 43.20.1 The severity was judged by the average of hearing thresholds between 250 Hz and 4,000 Hz.1 Sudden deafness is yet of unknown etiology, possibly a central lesion, a virus infection, a vasculopathy or an autoimmune disease. Relapsing sudden deafness with vertigo is often attributable to Ménière's disease or migrainous vertigo. 2,3 Most patients with benign paroxysmal positional vertigo (BPPV) are primary or idiopathic, approximately 15% of them follow an acute vestibular neuritis. Furthermore, although 8%~44% of them have a chronic ipsilateral sensorineural hearing loss, they are rarely associated with simultaneous ipsilateral sudden deafness, 4 and herein we report such a rare case from Taiwan.
A 44-year-old robust female Taiwanese has been bothered with right tinnitus up to six times after several nightsâ€™ staying up in recent seven years. The symptomatic duration was between one and two weeks and the symptom-free interval was between six and twelve months. When she was symptomatic, several secondsâ€™ vertigo could be induced several times a day by lying down or turning head rightward. There was no headache, blurred vision, paresthesia, nausea, ataxia or other focal neurologic symptoms. The previous four attacks were conservatively treated at other hospitals till August 2008 when she visited us for the 5th attack. Right Dix-Hallpike test was positive (Fig. 1A). The average hearing threshold was 38 dBHL in the right ear and 5 dBHL in the other. Over the following week, she was conservatively treated with prednisolone 20mg orally daily. The tinnitus and episodic vertigo remitted and average hearing threshold was 12dBHL in the right ear and 9 dBHL in the other.
Fig 1 here
During the 6th attack on March 2008, she visited the author again for a further study. The right Dix-Hallpike test showed positive again and the positioning vertigo could be cured by three ti
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Approved by the Higher Education Commission of Pakistan and Pakistan Medical and Dental Council
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