Timothy C. Hain, MD Page last modified: March 14, 2011
See also a discussion of Delayed Endolymphatic Hydrops
This patient experienced a basal skull fracture, 15 years ago, after falling off a ladder. He has had substantial noise exposure in his life. There was a contusion of the L frontal lobe, fluid in the left mastoid, and air adjacent to the left cerebellar hemisphere and left posterior temporal lobe. There was a lucency traversing the left posterior temporal bone. Blood was seeping from the left ear canal.
Audiometry at that time showed the following (a conductive hearing loss at low frequencies, some snhl high):
13 years later, he developed dizzy spells. There was no hearing fluctuation, tinnitus or fullness.
Audiometry at that time showed the following: (notch on R, HFSN on L).
Rotatory chair: (Normal at low frequency, suppression at high).
ECOG: High SP/AP ratio on L side.
VEMP: Lower on L side
Delayed endolymphatic hydrops is essentially the development of Meniere's disease, after an ear injury. Schuknecht (1990) suggested that it might be due to previous labyrinthitis. There are many other theories (see link).
In this case, the injury was likely a temporal bone fracture, as air was found within the cranial cavity. After 10 years, he developed dizziness, without the usual signs of Meniere's disease (i.e. no hearing fluctuation, tinnitus or fullness). A reasonable mechanism here might be scarring.
ECOG testing documented high pressure in the left ear (e.g. Hydrops).
Given the advances in MRI in recent years, it would be interesting to see if there is hydrops seen on MRI.