A 48-year-old woman, health worker, with no personal history of interest, unprotected against parotiditis virus, was given a first dose of MMR vaccine.
Three weeks later, the patient came to the ENT service due to sudden swelling and tinnitus in the left ear of several hours of evolution.
Physical examination revealed normal otoscopy and pathological audiometry.
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She was admitted with a diagnosis of sudden deafness in the left ear and started intravenous corticoid treatment and rest.
After audiometry similar to the previous one, an injection of intratympanic corticosteroids was administered.
Five days later, the patient was discharged with a descending pattern of corticosteroids, with no improvement in hearing.
After a second and third intratympanic injections a new audiometry was performed.
As there was no improvement, the patient was re-admitted for treatment with high-dose corticoids and metformin supplementation.
Magnetic Resonance Imaging does not detect expansive processes in the internal auditory canals, labyrinthallic walls with walls and cisterns of cerebellopontine cerebellopontine, normality.
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The patient was discharged with a diagnosis of sudden deafness of the left ear without hearing recovery.
There are no more cases reported in our hospital at the time of the adverse event, the batch showed no defects in its composition.
Reporting by the Department of Otorhinolaryngology (ORL) is due to several reasons: the patient does not relate vaccination with deafness due to the time elapsed between the administration of the vaccine and the adverse effect.
The intensity of the hypoacusis directed all the attention to try to reverse it and only after the failure, once all the therapeutic approaches reached were carried out, an attempt was made to find a triggering etiology of the same treatment in order to administer another alternative
During the process the worker is in temporary incapacity due to common disease.
The ENT service contacts the Occupational Risks Service (SPRL) to report the incidence two months after the onset of symptoms.
In SPRL we proceed to establish the causal link between the administration of the first dose of MMR vaccine and sudden deafness, since there is no previous history that could justify this pathology.
We review the literature to identify cases of auditory and vestibular involvement as a complication after vaccination, bibliographic references, in this respect, establishing the causal nexus (9, 10,11,12,13).
In compliance with the pharmacovigilance obligations, the adverse effects collection form is sent to the Pharmacovigilance Department of the laboratory involved.
The National Institute of Social Security (INSS) is asked to determine the contingency, since temporary disability has been due to a common disease, and questions arise about whether it is considered an occupational disease or an occupational accident.
Contingency could be considered as occupational disease for several reasons:
1. the RD 664/97 for protection of workers at risk of exposure to biological agents includes parotiditis virus in group 2.
2) The recommendation and administration of vaccination has a clear relationship with their work activity.
3) There are cases in the literature relating live attenuated virus vaccine (viral triple) with sensorineural hearing loss.
On the other hand, it could be considered a work-related accident, because the vaccine is given as prophylaxis to avoid parotitis in a health worker who is not protected against this virus, in case of possible exposure to the virus, other situation.
It seems unlikely that this is a common disease, finally notified as an accident at work, according to the General Law of Social Security and its relapse retroactively.
According to the disability assessment team of the Provincial Direction of the INSS, the worker is considered as a permanent non-invalidating lesion due to work accident: hearing loss that affects conversational zone amount of 2,420 euros, with a
We proceeded to the evaluation and clinical follow-up of the worker, once he returned to his job.
The worker presents an adaptive depressive-anxious disorder reactive to her stressful situation, identifiable with sudden deafness, initiating medical treatment and psychotherapy for resolution of the condition.
After performing a health surveillance examination in the SPRL, an aptitude report is issued without any limitation for their usual profession.
A disability was assessed by the Social Affairs Council, with a disability rate of 33%.
