Case history
Case history #1
A 56-year-old woman presents with a 3-week history of imbalance, right-sided hearing loss, and tinnitus. She reports having an upper respiratory tract infection 1 week before the onset of her symptoms. Her symptoms began with a severe episode of room-spinning vertigo with associated nausea and vomiting that lasted all day. The next day she noticed right, high-pitched tinnitus and was unable to use the telephone in her right ear. She now reports constant imbalance and slight vertigo with quick head turns to the right.
Case history #2
A 46-year-old man presents with a 1-year history of imbalance, deafness, and tinnitus. His symptoms began after being discharged from a prolonged admission to hospital secondary to pneumococcal meningitis.
Other presentations
Patients with bacterial meningitis are often critically ill and may present after resolution of the acute illness with profound hearing loss and imbalance without a history of acute vertigo.[2] Patients with syphilitic labyrinthitis can present with progressive hearing loss and pressure- or sound-induced vertigo (Hennebert and Tullio signs).[6] Syphilitic labyrinthitis may follow tertiary neurosyphilis that occurs many years after the primary infection, and is not seen with acute primary or secondary syphilis.[6] Labyrinthitis may also be associated with autoimmune inner ear disease (e.g., Cogan's syndrome or Behcet's disease).
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