A case of a 31-year-old male who developed profound sensorineural hearing loss following a heroin overdose is presented. The patient subsequently had a full recovery of his hearing. Other cases of this rare phenomenon are reviewed and management options are discussed. 1. Introduction There are only a few cases of heroin overdose associated hearing loss reported in the literature [1–5]. More common complications of heroin overdose include physical injury from falling or loss of consciousness, vomiting, and chest infections [6]. Well-known neurologic complications include peripheral neuropathy, temporary limb paralysis, transverse myelitis, seizures and stroke [6–8]. Recovery of hearing was seen in all but one of five cases of heroin overdose associated hearing loss. We present a patient who had SNHL with concomitant rhabdomyolysis after intravenous heroin overdose and provide a review of the literature. 2. Case Report A 31-year-old male with a history of opiate abuse, including previous overdoses, presented to the emergency department of an outside hospital after being found unresponsive by his family. Heroin was found at his bedside by his family. On presentation to the emergency department, he had pinpoint pupils, was hypotensive, and was difficult to arouse. He was given Naloxone and resuscitated with intravenous fluids. As his mental status improved, he complained of new onset bilateral hearing loss, abdominal pain, and nausea. His urine toxicology was positive for opiates and negative for all other substances. His blood chemistry was consistent with rhabdomyolysis with a creatinine of 1.4, lactate of 3.2, CPK of 2,397, and potassium of 6.0. He was admitted to the critical care unit for further management. A CT Head was performed that showed infratemporal air but was otherwise normal with no evidence of infarct. At the outside hospital, he was also given one dose of IV solumedrol 120？mg. He was stabilized and transferred to our institution for further evaluation. A formal audiogram was performed, which demonstrated moderate-to-severe bilateral sensorineural hearing loss. On his audiogram, he was noted to have very poor word discrimination bilaterally (Figure 1). His tympanograms were normal. An MRI/MRA was performed and showed no other abnormalities. He started on a one-week course of 60？mg prednisone daily and then a one-week tapered course. His rhabdomyolysis resolved with intravenous fluids and he was discharged home on hospital day 4. Figure 1: Initial pure-tone audiogram showing bilateral moderate to severe sensorineural hearing loss and speech
References
[1]
A. Ishiyama, G. Ishiyama, R. W. Baloh, and C. J. Evans, “Heroin-induced reversible profound deafness and vestibular dysfunction,” Addiction, vol. 96, no. 9, pp. 1363–1364, 2001.
[2]
G. Mulch and M. Handrock, “Sudden binaural deafness after acute heroin intoxication,” Laryngologie Rhinologie Otologie, vol. 58, no. 5, pp. 435–437, 1979.
[3]
A. Schrock, M. Jakob, S. Wirz, and F. Bootz, “Sudden sensorineural hearing loss after heroin injection,” European Archives of Oto-Rhino-Laryngology, vol. 265, no. 5, pp. 603–606, 2008.
[4]
S. Polpathapee, P. Tuchinda, and S. Chiwapong, “Sensorineural hearing loss in a heroin addict,” Journal of the Medical Association of Thailand, vol. 67, no. 1, pp. 57–60, 1984.
[5]
E. L. Nair, K. M. Cienkowski, and E. Michaelides, “The impact of sudden hearing loss secondary to heroin overdose on fitting outcomes,” American Journal of Audiology, vol. 19, no. 2, pp. 86–90, 2010.
[6]
M. Warner-Smith, S. Darke, and C. Day, “Morbidity associated with non-fatal heroin overdose,” Addiction, vol. 97, no. 8, pp. 963–967, 2002.
[7]
J. Pascual Calvet, A. Pou, J. Pedro-Botet, and J. Gutiérrez Cebollada, “Noninfections neurological complications associated to heroin adiction,” Archivos de Neurobiologia, vol. 52, supplement 1, pp. 155–161, 1989.
[8]
V. Sahni, D. Garg, S. Garg, S. K. Agarwal, and N. P. Singh, “Unusual complications of heroin abuse: transverse myelitis, rhabdomyolysis, compartment syndrome, and ARF,” Clinical Toxicology, vol. 46, no. 2, pp. 153–155, 2008.
[9]
A. Pirodda, G. G. Ferri, G. C. Modugno, and C. Borghi, “Systemic hypotension and the development of acute sensorineural hearing loss in young healthy subjects,” Archives of Otolaryngology, vol. 127, no. 9, pp. 1049–1052, 2001.
[10]
A. Pirodda, G. G. Ferri, G. C. Modugno, and A. Gaddi, “Hypotension and sensorineural hearing loss: a possible correlation,” Acta Oto-Laryngologica, vol. 119, no. 7, pp. 758–762, 1999.
[11]
N. Jongkamonwiwat, P. Phansuwan-Pujito, S. O. Casalotti, A. Forge, H. Dodson, and P. Govitrapong, “The existence of opioid receptors in the cochlea of guinea pigs,” European Journal of Neuroscience, vol. 23, no. 10, pp. 2701–2711, 2006.
[12]
N. Jongkamonwiwat, P. Phansuwan-Pujito, P. Sarapoke et al., “The presence of opioid receptors in rat inner ear,” Hearing Research, vol. 181, no. 1-2, pp. 85–93, 2003.
[13]
E. Soto and R. Vega, “Neuropharmacology of vestibular system disorders,” Current Neuropharmacology, vol. 8, no. 1, pp. 26–40, 2010.
[14]
T. Ho, J. T. Vrabec, and A. W. Burton, “Hydrocodone use and sensorineural hearing loss,” Pain Physician, vol. 10, no. 3, pp. 467–472, 2007.
[15]
A. A. Muller, K. C. Osterhoudt, and W. Wingert, “Heroin: what's in the mix?” Annals of Emergency Medicine, vol. 50, no. 3, pp. 352–353, 2007.
[16]
K. A. Phillips, G. A. Hirsch, D. H. Epstein, and K. L. Preston, “Cardiac complications of unwitting co-injection of quinine/quinidine with heroin in an intravenous drug user,” Journal of General Internal Medicine, vol. 27, no. 12, pp. 1722–1725, 2012.
