Partial Recovery of Audiological, Vestibular, and Radiological Findings following Spontaneous Intralabyrinthine Haemorrhage

The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities. 1. Introduction Sudden sensorineural hearing loss (SSNHL) was first described by de Kleyn in 1944 [1]. Today, it is defined as a sensori-neural hearing loss of >30？dB across at least 3 consecutive frequencies arising in <72 hours [2, 3]. It is generally unilateral and reports of its annual incidence vary from 5 to 300/100,000 [4, 5]. Up to 90% of cases are idiopathic [6] and treatment is generally with steroids, though the evidence supporting this is controversial [7–9] especially as spontaneous improvement occurs in >50% of patients within 2 weeks [6, 10, 11]. The specific type of steroid, its dose/duration, and method of delivery vary widely from unit to unit. Our unit uses very high dose oral dexamethasone and we have recently published encouraging results [12]. Intralabyrinthine haemorrhage (ILH) as a cause of SSNHL is extremely rare, and there have been few such reports in the literature [13–18]. The relationship of vestibular symptoms with spontaneous ILH is also unclear. Generally, haemorrhage occurs in patients with coagulopathies as seen in leukaemia or with anticoagulant medication and very few patients enjoy any recovery of function. 2. Case Report A 50-year-old journalist presented to the ENT department at the University Hospital Zurich, with left-sided tinnitus, hearing loss, and general dizziness without real vertigo. The symptoms had suddenly appeared whilst at work a month previously and he had been treated by a private ENT doctor with oral prednisolone (50？mg daily for 10 days), betahistine, magnesium, and flunarizine with a diagnosis of an acute idiopathic vestibulocochlear loss. During this time his hearing loss had remained, but his dizziness symptoms had almost completely resolved. He also complained of tinnitus and a pressure sensation on the left ear. There was no further medical history of note other than that he took 100？mg aspirin daily because of borderline increased hematocrit. He