Differential Diagnosis
The patient was treated for bilateral labyrinthitis with prednisolone
60mg once daily (OD), tapering the dose by 10mg daily, and his symptoms
improved. He was then discharged with a follow-up plan for vestibular
rehabilitation and balance clinic.
Less than 2 weeks later, the patient presented to ED again with a
relapse of his symptoms. A repeat audiogram showed moderate, symmetrical
hearing loss (Figure 1c ). Routine blood tests showed a mildly
raised neutrophil count again but was otherwise unremarkable. Further
investigations were conducted, including an autoimmune screen to exclude
other systemic autoimmune disease, myeloma screen and Treponemal
antibody testing, all of which were negative (Table 1 ). The
patient was treated with a second course of high-dose prednisolone 60mg
OD and discharged home with an urgent follow-up in Emergency ENT Clinic,
where he was prescribed a further week course of prednisolone 60mg. He
was then referred to the Vestibular Rehabilitation Team and Rheumatology
for suspected AIED. The patient was started on bilateral intratympanic
Solu-Medrone injections by ENT and an 8-week tapering course of
prednisolone 40mg OD by Rheumatology. He was also referred to a combined
Rheumatology and ENT specialist centre where he received further
investigations that confirmed the diagnosis as AIED. This included
cortical evoked response audiometry which showed that both ears have
mid-frequency hearing loss of around 60dB and higher frequency hearing
loss of over 100dB.