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.