Interesting Case

Earsense earsense at
Sun Oct 5 14:42:49 EST 1997

I had an interesting case recently and would appreciate any advice regarding
it.  A patient of mine had a car accident about 2 months ago and had been 
receiving physical therapy. The patient claimed 2 weeks ago that the physical
therapist twisted their neck during a therapy session, and the following 
day  woke up with no hearing in both ears. This incident happened about 2 weeks
 ago, and the patient is claiming total hearing loss in both ears, with 
a "static" like noise in both ears. The patient denied significant
 imbalance/dizziness problems. Other case history information was unremarkable.
The patient claims essentially normal hearing and no otologic problems
before the incident.The patient claims they now communicate via lip reading
 only.The patient responded very well to questions during case history
and test instructions, however  did not respond at all when attempts to prevent
lip reading occurred.

The audiologic evaluation took place two weeks following the incident. The
did not respond to pure tone or speech stimuli for either ear at equipment
limits ( >110 dbHL). No responses at all. Tympanometry revealed type A
 tympanograms for both ears. Acoustic reflex thresholds were between 90-95 dB
at 500Hz-2000 Hz for ipsilateral stimulation for the left ear, and were largely
absent for ipsilateral stimulation for the right ear. Contralateral acoustic
were essentially absent, or elevated (105-110 dB) for both ears. 

DPOAE testing revealed cochlear emissions present 500 Hz-2000 for the left ear,
and absent above 2000 Hz. Cochlear emissions were essentially absent for the 
right ear. 

What do you think about this case study?. How would you interpret it? AR and 
OAE results suggest hearing thresholds better than 40 dBHL 500Hz-2000Hz
for the left ear, and possibly a moderately severe to profound snhl for the
 right ear.
Behavioral results are not in good agreement with physiologic findings on the 
left ear.

The patient appears remarkably adept at lip reading, considering they suffered
a sudden total loss of hearing in both ears (just two weeks ago).
Any suggestions regarding interpretation? Further testing? (possible ABR or
Counseling? Legal Ramifications?
I would appreciate any advice/help on this case.

P.S. I read in the Hearing Journal months ago about cervical manipulation and 
sudden hearing loss. I guess the cervical artery has a branch called the
basilar artery- which supplies the inner ear. So I guess the patient's claims
not completely out of the range of possibilities. Correct me if I'm wrong.

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