QUIZ: Permanent buzzing

Tuesday, 27 October 2009 20:39

Case description: 57-years old male, has been complaining about a permanent buzzing in his ears for 15 years. 2 years ago he had an episode of temporal loss unconsciousness - he didn't recognise his relatives, his surroundings, had no orientation in time and space. The symptoms were particularly intense during the time of fatigue or after a lack of sleep. The patient doesn't smoke, drinks occasionally, in the past - episodes of high glycemia.

Results of the possessed laboratory tests: Cerebral blood flows - without contractions. CT - without aberrations. Fasting glycemia - 105.

QUIZ question: The man still doesn't have any diagnosis and effective treatment. What would you suggest?

Comments

0 #1 Radecki 2009-10-27 22:12

Was a lipidography made? ECG? Was the blood flow measured also on the lower libs? What was CBC like?

0 #2 Mateusz Palczewski 2009-10-28 15:03

CBC, ECG and lipidogram all normal. The blood flow on the limbs wasn't made - why? Would you like to do them?

0 #3 Radecki 2009-10-28 16:29

Perhaps a otolaryngologis ts consultation is in order? Ear buzzing, loss of consciousness are common with balance disorders, otolith shifts in e.g. labyrinthine hydrops

0 #4 szadziu 2009-10-28 17:48

What's with CBC, Diabetes type II, untreated?

0 #5 Patty 2009-10-28 19:30

Perhaps a poorly treated diabetes... hypoglycemia could give such symptoms.

0 #6 A_Piekarska 2009-10-28 20:36

Perhaps a subclavian steal syndrome - but that would result in a buzz in one ear, not both. I'm also thinking about some lysosomal storage disease, which has increased symptoms during weakness and lack of sleep. Unfortunately I can't remember the exact name. From the additional tests I'd order liver enzymes, or I'm willing to side with Patty - poorly treated diabetes?

0 #7 Mateusz Palczewski 2009-10-28 20:51

Because it's a genuine and undiagnosed case I think we should confirm whether there is diabetes or not - the 105 fastening glycemia doesn't fit in my opinion. I've checked that there is no lipidography. The diet is rich in fats so it would be good to have those results.

Radecki: The numerous acute ear infections in childhood should be explained.

I'll post more info when I'll get it.

0 #8 kowalskimd 2009-10-30 10:27

Apart from the buzzing, does the patient complain of any hearing loss (one- or both-sided)?

0 #9 slowik 2009-10-30 16:48

The buzzing are unspecific, especially in this interview - that could be explained by irreversible after-infection changes, the loss of consciousness could be a result of something vascular - a microthrombus? what about this consultation? Did he loose his consciousness only once? How long before he recovered from it?

0 #10 kowalskimd 2009-10-30 19:51

What is the Schwartz's sign?

0 #11 slowik 2009-10-30 22:14

The fasting glycemia alone is not very competent, I'd do glucose tolerance tests and I'm suspecting a TIA

0 #12 Jaga 2009-11-01 16:34

What's the patients' audiogram? Does the patients' hearing deteriorates, episodes of balance disorders? What's the character of this buzz? High- or low-pitched, synchronized with his pulse?

0 #13 skalczyk 2009-11-01 19:33

Did the patient have any head traumas in the past?
Was the patient hospitalized due to other causes?
Was an EEG made after his loss of consciousness, or did he have one made recently?
Is he being treated for something chronic?
Any allergies?

0 #14 skalczyk 2009-11-01 19:36

One more thing, does the patient have vertigo?

0 #15 vienio 2009-11-01 21:39

- No major head traumas, some minor ones in the past - motorcycle accidents, hockey etc. ;
- No, tonsillectomy at the age of 40;
- After loss of consciousness a CT (without contrast) was made - no abnormalities;
- Doesn't take any chronic drugs;
- No allergies;
- audiogram: High tones impairment;

The buzz is low pitched, unidentified: cannot tell if it's inside the ear or the head, cannot define the source;

In early youth, he had 2 infections of middle ear, with pain and pus
Additional remark: ex-sportsman, strong build; a noticeable loss of condition

0 #16 vienio 2009-11-01 21:40

Vertigo - no

0 #17 skalczyk 2009-11-01 22:59

I'd suggest another CT, with contrast this time or MRI in search of micro-aneurysms, including the middle and inner ear. The loss of condition could be caused by a heart disorder, I'd do an ECG as well as Cardiac stress test with saturation levels. I'd ask what is exactly the matter when talking about the loss of condition, does he have trouble catching breath, no strength in muscles. Because of the glycemia I'd repeat the fastening glycemia, do a glycated hemoglobin and OGTT. In addition a otoscopy with samples for cultures taken from external auditory meatus and eardrum area.