A word about curable deafness
here are only two types of deafness,” observed Sir William Wilde, the distinguished Dublin ear surgeon, in an epigram his son, Oscar, would have been proud of: “One is due to ear wax and is curable. The other is not due to wax and is not curable.”
Though certainly succinct, like many epigrams, this is not strictly accurate. Deafness in children, in particular, may be due to glue ear, remedied nowadays by the popular operation of inserting grommets.
And as ENT specialist Jonathan Fishman reported recently in the
British Medical Journal, there is a further important category of curable deafness, illustrated by a 55-year-old woman who unexpectedly found she was having difficulty conversing with her husband across the dinner table one evening. This type of acute (rather than gradual) hearing loss is, not surprisingly, significant. Though probably attributable to a viral infection involving the inner ear, it is rather long-windedly known as idiopathic (ie cause unknown) sudden sensorineural hearing loss (ISSHL). Those so afflicted should seek prompt medical attention (perplexingly, not all do) as a course of steroids increases the likelihood of a full recovery. This is fairly straightforward, the catch being that despite the improvement with steroids, the sudden hearing loss may, in fact, be due to an acoustic neuroma, a benign tumour of the auditory nerve. Hence, those with ISSHL should also have an MRI scan as its appropriate treatment is very different.
As for Jonathan Fishman’s patient, her MRI scan was normal but, despite treatment with steroids, she was left with residual deafness in the left ear, so now requires a hearing aid to keep up with the conversation over the dinner table.
Funny-feeling feet
This week’s medical query comes courtesy of Mrs ML from Lancashire, in her early 60s, fit and healthy from playing a lot of tennis and fell-walking. Last year when on a cycling tour of France, she developed pins and needles across both the front of her feet, followed by numbness and a “jellylike feeling”. This has persisted ever since, exacerbated by exertion and wearing tight footwear, improving modestly after a few days’ rest.
This certainly sounds like faulty functioning of the sensory nerves to the feet (peripheral neuropathy), but surprisingly the relevant investigation of nerve conduction studies was normal. Physical examination of the feet and back are similarly unrevealing and her specialist admits to being “at a bit of a loss to advise on a diagnosis”. Any suggestions would be gratefully received.
Faint praise
The habit of keeling over in church, recently featured in this column, is not confined to more elderly parishioners, as a correspondent recalls from an outbreak of fainting in chapel when at the girls’ boarding school Roedean in the Sixties. The unfortunate fainters were admonished for their attention-seeking behaviour, not least as none of the choir (to which she belonged) was affected.
The mysterious outbreak continued until an engineer performed a routine service on the heating in the chapel. “Do you have a problem with girls fainting during a long service?” he apparently inquired, having discovered the system was pumping out carbon monoxide. The gas did not apparently permeate up into the gallery – hence the sparing of the choir.
“Things went boringly back to normal after that,” she writes.
Lip service
Finally, further to the ongoing discussion about the cure for nocturnal cramps, a reader with a retentive memory recalls an item in this column from 14 years ago, explaining the merits of tightly squeezing the upper lip at its centre point between the thumb and index finger. “The first time I tried it, I only had to squeeze for 15 seconds to relax my calf muscles,” he writes, and has since recommended it widely to his friends and, as far as he is aware, it has worked for all of them.
That there are only two types of hearing loss is not strictly accurate. It may now be remedied