'I Can't Hear': Evaluating Patients With Hearing Loss

Gordon H. Sun, MD, MS

Disclosures

September 29, 2017

Buzzing and Unilateral Hearing Loss

A 59-year-old man presented to a local emergency department with a complaint of sudden inability to hear anything in his left ear for the past 4 days. He experienced occasional "buzzing" sounds in both ears (worse on the left). The patient denied otalgia, otorrhea, vertigo, or sensation of fullness in either ear, as well as recent fevers, chills, or other illnesses. He had no new-onset visual deficits, shortness of breath, dysphagia, dysphonia, facial weakness, or numbness and reported no recent head trauma or surgery. His medical history was remarkable for hypertension and type 2 diabetes, both of which were being well-controlled with medications. He reported no drug allergies or recent changes in his medication regimen. The patient quit smoking 10 years ago and does not drink alcohol.

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Physical examination demonstrated a well-developed and well-nourished but anxious man. Vital signs were within normal limits. An external ear exam was unremarkable. Otoscopy demonstrated clear external auditory canals and intact tympanic membranes without evidence of effusion. Pupils were equal and reactive to light, and extraocular movements were normal. No nystagmus was noted. Nasal and oral exams demonstrated no pertinent findings. There was no tenderness of the mastoids, jaw, or neck.

Facial nerve function was fully intact bilaterally. Weber testing with a 512-Hz tuning fork lateralized to the right. Rinne testing was normal on the right but could not be performed on the left due to the patient's inability to hear the tuning fork. He demonstrated no other motor or sensory deficits.

The physician suspected left-sided sudden sensorineural hearing loss (SSNHL) and referred the patient to the hospital audiologist for further testing.

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