CASE PRESENTATION

Sudden Sensorineural hearing Loss

Supervisor :
dr. H. Oscar Djauhari, Sp. THT

Presented by
Betharlitha Maharlika
2012730018
Identity
Name : Mr. N
Age : 30 years old
Gender : Male
Occupation : Labor
Weight : 52 kg
Address : KP. Cihereus, Cibadak
Complaints
Chief complaint : sudden deafness

Additional complaint :
dizziness
headache
History of Present Illness
The patient came to the hospital with complaints sudden deafness
within 4 hours ago on his left ear. The patient feel dizziness and
headache since 2 day ago. 2 day ago, the patient suffering blunt
trauma to the head from motorcycle accident.

History of previous treatment:

She was treated for her left shoulder pain.
History of Past Illness
The patient denied the history of high blood pressure, diabetes
mellitus, coagulopathies, allergy and infection of the nose, ear and
throat before.
The patient never previously had similar complaint as now.
History of Past Illness
History of tumor (-)
History of allergy (-)
History of hypertension (-)
History of diabetes mellitus (-)
General Physical Examination
General appearance : moderate ill
Consciousness : compos mentis
Blood pressure : 110/70 mmHg
Heart rate : 88x/min
Respiratory rate : 24x/min
Temperature : 36.5oC
Physical examination

Head : hematoma at left temporal regio.

Bruise and laseration at left shoulder regio.
 ENT Physical examination
AURICLE
Right Auricle
External ear : hyperemic(-), deformity(-), laceration (-), mass (-), pain (-)
External acoustic canal : hyperemic(-), edema(-), laceration(-), secretion(-), cerumen (-),
mass(-)
Tymphanic membrane : intact, light reflex(+) normal
Whisper test : normal

Left Auricle
External ear : hematome (+), laceration(+), mass(-), pain(+)
External acoustic canal : hyperemic(-), edema(-), mass(-), laceration(-), secretion (-),
cerumen(-), mass(-).
Tympanic membrane : intact, light reflect(+) normal
Whisper test : difficulty with moderate whispering voice
Nasal cavity
Right Nose :
Mucous membrane : within normal range
Concha : eutrophy
Cavum : discharge(-),mass (-),crust (-),bleeding (-)
Septum : normal

Left nose :
Mucous membrane : within normal range
Concha : eutrophy
Cavum : discharge(-),mass (-),crust (-),bleeding (-)
Septum : normal
 Nasopharynx, Oropharynx, Maxilofascial,
and Neck

NPOP
Mucous membrane : hyperemic -/-, oedem -/-
Arcus anterior : uvula in the middle, mass -/-
Pharynx : normal pharyngeal arch, hyperemic (-)
Tonsil : T1-T1, hyperemic (-)

Neck : lymphadenopathy (-)

Physical Examination (Facial Nerve)
Facial Nerve Examination (right / left)
Facial expression : symmetric
Raising eyebrow : normal / normal
Closing eyes : normal/ normal
Smiling : normal/ normal
RESUME
Man, 30 years old, came with complaints sudden deafness within 4 hours
ago on his left ear. additional complaints is dizziness and headache since
2 day ago. There is history of head trauma about 1 day ago.

Physical examination:
o Left Auricle
o External ear : hematome (+), laceration(+) pain(+)
o Whisper test : difficulty with moderate whispering voice
o Head : hematoma at left temporal regio.
o Bruise and laseration at left shoulder regio.
WORKING DIAGNOSIS
Sudden deafness e.c temporal bone fracture
DIFFERENTIAL DIAGNOSIS
Post-traumatic Menieres syndrome
Suggestion
Complete blood count
Audiometry
BERA
SISI (Short Increment Sensitivity Index)
Tympanometry
CT Scan and MRI with gadolinium
TREATMENT
o Vasodilators
Papaverine, procaine, niacin, and carbogen (30 minute 6x/day for 5 day)
o Hyperbaric oxygen
100% O2 for 60 minute 1-2 x/day
o Rheologic agents
poentoxifylline 400mg PO 3-4 week
o Antiinflammatory agents
Prednisone 1 mg/kg/day Maximum 60mg/day
o Surgery
LITERATURE REVIEW
 SUDDEN SENSORINEURAL
HEARING LOSS

Sudden hearing loss is a sudden loss of hearing which is usually the

sensorineural type. Sensorineural hearing loss may be defined as the
loss of hearing more than 30dB within 3 consecutive frequency in
audiometry and in less than 3 days, and usually unilateral.
o Bilateral progressive hearing loss

o This usually results from the ageing process such as prebyacussis, drug
ototoxicity (aminoglycosides). The risk is greater for people with renal
impairment, and chronic loud noise exposure. The severity depends on the
internsity and the duration of the exposure, and individuals susceptibility.
o Unilateral progressive hearing loss

o Suggestive of Menieres and acoustic neuroma (schwanoma)

o Sudden sensorineural hearing loss

o This type of hearing loss is usually unilateral, and may result from trauma

o Leak of perylimph from the oval or the round window ( barotrauma)

o Viral infection (mumps, measles, varicella zoster, and syphillis)

o Sudden impairment of cochlear blood flow

PRESENTATION

Full or blocked ear

Dizziness in 30-40%

Tinnitus
WORK UP

Complete blood count

Audiometry
BERA
SISI (Short Increment Sensitivity Index)
Tympanometry
CT Scan and MRI with gadolinium
TREATMENT
o Vasodilators
Papaverine, procaine, niacin, and carbogen (30 minute 6x/day for 5 day
o Hyperbaric oxygen
100% O2 for 60 minute 1-2 x/day
o Rheologicagents
poentoxifylline 400mg PO 3-4 week
o Antiinflammatory agents
Prednisone 1 mg/kg/day Maximum 60mg/day
o Antiviral agents
Acyclovir 800mg PO 5x/d 7 day
famciclovir 250mg PO 7 day
o Surgery
if associated with a positive fistula test or history of recent trauma or
barotrauma