Sudden Profound Bilateral Hearing Loss Associated with Polysubstance Narcotic Overdose

Objective: To present a rare case report of a teenager who developed sudden bilateral moderately-severe sensorineural hearing loss following a night of polysubstance abuse that resolved with pentoxifylline therapy. Presentation, audiologic findings, associated co-morbidities, treatment options, and potential etiologies are discussed. Study Design: Case report and review of literature. Methods: Chart review of an 18-year-old female who presented two days after a binge of polysubstance abuse with sudden-onset bilateral hearing loss. Workup included MRI / CT brain imaging, lumbar puncture, and infectious disease / autoimmune screening. Results: The patient admitted to using heroin, benzodiazepines and cocaine one night prior to developing bilateral moderately-severe sensorineural hearing loss (60 dB SRT/ 60% discrimination). The hearing loss was initially treated with high-dose oral prednisone and antiviral therapy without resolution, followed by a ten month course of pentoxifylline with subsequent hearing improvement no longer requiring hearing-aid amplification (normal speech audiometry, 15dB SRT / 90% discrimination) and only residual high-frequency sensorineural hearing loss (3-8 kHz). Conclusion: This case report highlights the importance of recreational drug abuse history when evaluating patients with sudden onset hearing loss. Several cases have been reported in the literature with sudden hearing loss requiring cochlear implantation following hydrocodone / acetaminophen abuse. Potential etiologies include altered pharmacokinetics, vascular spasm / ischemia, encephalopathy, acute intralabyrinthine injury and genetic polymorphisms of drug metabolizing enzymes. • Six days following the onset of hearing loss, the patient presented to our office for a second opinion. • She continued to complain of bilateral ear fullness and tinnitus. Her physical examination findings were within normal limits. Figure 1A and 1B show results from her audiological evaluation after only four days of prednisone 60 mg daily and valacyclovir 1000 mg three times a day. • Following the audiologic and otologic examination, the patient was continued on prednisone 60 mg daily for four week and started on pentoxifylline 400 mg three times daily. • A complete audiological evaluation was carried out one month after onset of the initial symptoms. Immittance measures were consistent with normal middle ear function, characterized by normal Type A tympanograms, normal static immittance, and a return of acoustic reflexes. Uncrossed reflexes were within normal limits, although crossed acoustic reflexes remained elevated at most frequencies. Hearing sensitivity continued to show improvement and was at near normal levels below 1500 Hz, with a symmetric mild to moderate sensorineural hearing loss above. Word recognition scores were 88% bilaterally. • …