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Abstract: Sudden hearing impairment, called sudden deafness, is a common otolaryngological disorder, of which the total deafness type with vertigo has the worst prognosis. In this case, the child had sudden onset of vertigo, vomiting, with tinnitus and hearing loss, and was diagnosed with sudden deafness in the left ear combined with secretory otitis media in the right ear. After seeking medical attention, the child’s hearing improved significantly through a combination of medication and vestibular rehabilitation training. Therefore, it is important to visit the ENT department in time to avoid delaying the disease.
Basic information】Male, 11 years old
Disease Type】Sudden deafness (left ear), secretory otitis media (right ear)
Hospital】Qilu Hospital of Shandong University
Consultation time】May 2018
【Treatment plan】The 1st course: intravenous infusion (methylprednisolone, Ginkgo biloba extract injection , prostaglandin, methylcobalamin, lipoic acid) + oral (betahistine mesylate tablets, eucalyptus lemongrass enteric soft capsule) + vestibular rehabilitation training + nasal spray (fluticasone propionate nasal spray )
. Course 2: intravenous infusion (Ginkgo biloba extract injection, lipoic acid, methylcobalamin) + drug intramuscular injection (murine nerve growth factor) + nasal spray (fluticasone propionate nasal spray) + oral (betahistine mesylate tablets, eucalyptus citrulline enteric soft capsule) + left postauricular drug injection (dexamethasone)
Treatment period】Hospitalization for 20 days, outpatient follow-up for 1 month
Treatment effect]: The vertigo was relieved and the bilateral hearing improved significantly.
I. Initial consultation
The child was poor in spirit and vomited intermittently. He reported sudden onset of vertigo, tinnitus and hearing loss in the left ear 4 days ago, and had been hospitalized in a local hospital for 3 days with poor results.
On examination, the child was found to have rightward horizontal spontaneous nystagmus, intact tympanic membrane in the left ear, and cloudy and invaginated tympanic membrane in the right ear; the hearing examination was completed, suggesting extremely severe sensorineural deafness in the left ear and mild conductive deafness in the right ear, and the acoustic conduction resistance had an A curve in the left ear and a B curve in the right ear.
The child was diagnosed with sudden deafness in the left ear combined with secretory otitis media in the right ear.
II. Treatment history
We explained to the parents and the child that the vertigo was caused by the sudden deafness in the left ear, and after the child and the family agreed, the child was immediately treated with fluids (methylprednisolone, Ginkgo biloba extract injection, prostaglandin, methylcobalamin, lipoic acid) and oral betahistine mesylate tablets. At the same time, there is secretory otitis media in the right ear, which also needs to be treated actively, with fluticasone propionate nasal spray and oral eucalyptus pinene enteric soft capsule.
After one course of treatment (10 days), we further communicated with the child and his family and started the second course of treatment, continuing the infusion (Ginkgo biloba extract injection, lipoic acid, methylcobalamin) and intramuscular injection (rat nerve growth factor). After the second course of treatment, the patient’s condition improved significantly and was discharged at the end of 20 days of hospitalization, and the patient was asked to follow up for 1 month in the outpatient clinic.
III. Treatment effect
After the first course of treatment, the child’s vertigo was significantly reduced, the symptoms of unstable walking were improved, and the tinnitus in the left ear was relieved, but the hearing did not improve significantly.
After the second course of treatment, the child’s hearing improved significantly in both ears, and the recheck hearing indicated normal hearing in the right ear and 30 dB improvement in the left ear at low and medium frequencies, and the acoustic impedance was binaural type A curve, and there was no significant vertigo. Outpatient follow-up for 1 month indicated that the child recovered well and his condition was effectively improved.
Hearing result after 1 course of treatment
Hearing result after 2 courses of treatment
IV. Notes
We are very happy that the child’s vertigo has been relieved and bilateral hearing has improved significantly, but the following points should be noted.
1.We suggest that the child should relax after discharge, ensure sleep, avoid staying up late, pay attention to the combination of work and rest, and maintain a regular routine.
2, the child continues vestibular rehabilitation training, daily ball sports, such as table tennis and badminton, to promote vestibular rehabilitation.
3. The child should have a low-salt and low-fat diet and take oral medication for 1 month (betahistine mesylate tablets, Ginkgo biloba extract tablets, cytarabine, methylcobalamin).
4. Avoid noise and ototoxic drugs, and keep an eye on the child’s ears to see if there is any further hearing loss.
V. Personal insight
Sudden deafness is a common otolaryngological disorder. The effectiveness of treatment for this disease depends on the time to seek medical treatment after the onset of the disease, and those who seek medical treatment more than 1 month after the onset of the disease will delay the best treatment time. The cause of sudden deafness is unknown and may be related to vascular diseases, viral infections, etc. Also, mental tension, stress, mood swings, irregularities in life, and sleep disorders can trigger this disease. Therefore, we should pay attention to avoid noise environment and ototoxic drugs in our daily life to prevent sudden deafness, and if there are uncomfortable symptoms in the ear, we should seek medical treatment early to prevent the condition from deteriorating. After treatment, it is also necessary to pay attention to self-protection to avoid the recurrence of the disease.