A 62-year-old woman with a history of hypertension, hypercholesterolemia and hypertriglyceridemia.
Urological diagnosis of high grade bladder cancer (Carlanoma of transitional cells G3 p53+ and Carma in situ in sample 1 of standardised multiple biopsy).
After radical cystectomy with Studer-type bladder reconstruction (carma urothelial G3 solid pattern, pt3b, negative nodes) presents sepsis of urinary origin admitted to intensive semi-critical antibiotic treatment.
Three days after admission the patient reported sudden onset tinnitus accompanied by significant bilateral hearing loss.
The patient did not present vertigo or instability.
There was no earache or otodynia or sensation of ear fullness.
Facial mobility was preserved.
Physical examination revealed normal hearing loss, with profound audiometry of the right ear and cophosis of the left ear, with normal impedance.
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Once the neurosensory character of hearing loss was confirmed, a review of the patient's medical history and a new anamnesis were performed to perform the etiological study.
After excluding the relationship with systemic diseases, intracranial infections and trauma, hearing loss was attributed to the administration of intravenous furosemide in the initial management of septic shock.
Furosemide was discontinued and the association of other ototoxic drugs was prescribed.
We proceeded according to the protocol of sudden hypoacusis to treatment with parenteral corticosteroids at high doses (Methylprednisolone 120 mg/24) and oral pentoxyphylline.
(400 mg/ 8 h).
After 7 days of parenteral treatment oral corticosteroids were continued in descending order for 14 additional days (Prednisone 60 mg/day 7 days and 30 mg/day 7 days), maintaining the same dose for pentoxyphylline.
The audiometry at two weeks of treatment showed improvement of tonal hearing with the appearance of severe auditory remains in the left ear and the rise of thresholds in the right ear.
1.
At 6 months of treatment the patient recovered hearing in the right ear up to 58%.
The left ear has auditory remains in severe frequencies, but no clear recovery has been observed.
The patient is still being monitored in our centre, and the adaptation of an acoustic prosthesis in the right ear has been recommended.
Oncologically, she has started chemotherapy, without affecting her hearing levels.
