Case Study 1

This patient is a 63-year-old business executive, who came in initially January 2010. He had a right acoustic neuroma treated elsewhere with Gamma Knife stereotactic radiation in 1993, and did well until 2009, when he noted a sudden drop in hearing in his left, only hearing ear. When seen initially in the office, he had a severe hearing loss with no useful hearing in the right ear, and an overall 15% hearing loss in the left ear. He was begun on a diuretic, and was also treated with steroid injections both through the ear drum and by mouth, and his hearing improved back to a very mild 5% loss.

Unfortunately, when the effects of the steroid wore off, his hearing would become unstable again with a significant hearing loss in the the left ear requiring additional steroid treatment. The fact that his hearing responded so well to steroids suggested an inflammatory cause for his unstable hearing. In an attempt to determine why he required steroids to maintain his hearing, laboratory testing was performed, that did not reveal any underlying autoimmune nor inflammatory disease. However, it was noted that he had a past history of allergies, and in fact required allergy shots all through childhood. He also had a strong family history of allergy. Consideration was given that underlying airborne and/or food allergies might actually be a source of the inflammation affecting his hearing.

He underwent diagnostic testing for allergy in March 2010 and was found to have significant environmental allergies, but no food allergies. He was begun both on allergy shots weekly, and also given a prescription for an anti-viral, as there is some evidence that that may help certain forms of unstable hearing. He has done extremely well on treatment, with his hearing normalizing within three months of starting allergy therapy. It has been normal in his left ear for almost 2 years.

In addition to his allergy therapy, the patient has been very diligent about following a strict 1000 milligrams per day low-sodium diet, and continues to take his diuretic on a daily basis. His hearing is the right ear has also improved, allowing him to wear a hearing aid with good benefit.

In some cases, steroid dependent hearing loss may actually be related to underlying allergies. There are treatments for this which are more physiologic than taking steroids on a frequent basis.