ABSTRACT
Figure 10.40 History: A 42-year-old man with sudden hearing loss and rushing tinnitus in the right ear. Symptoms present for 6 months when first seen for examination. Has slight difficulty distinguishing certain sounds. Feels occasional fullness in the right ear. No vertigo. Otologic: Normal with normal caloric responses. Audiologic: Left ear normal. Right has a high-frequency loss with complete recruitment at 2000Hz. No abnormal tone decay. Diplacusis with 2000-Hz tone. Discrimination score: Right, 4%. Classification: Sensory hearing loss. Diagnasis: Meniere's disease. Aids to diagnasis: This man worked in a noisy environment, and his unilateral hearing loss originally was misdiagnosed as occupationally related deafness. The presence of complete recruitment, diplacusis, and discrimination difficulty point to sensory hearing loss and probably Meniere's disease without vertigo. In this case the diagnosis was confirmed months later when the patient developed attacks of rotary vertigo. His hearing then changed to levels similar to those in Fig.10.6. Both the unilateral impairment with depression at 8000Hz and the relatively low noise level (90 dB overall) in the allegedly "noisy plant" mitigated against a diagnosis of noise-induced hearing loss.
