A 50-year-old woman was seen in the emergency department at Massachusetts Eye and Ear Infirmary (MEEI), affiliated with this hospital, because of pain and decreased hearing in the left ear.
The patient had been in her usual state of health until 6 weeks earlier, when she noted decreased hearing, discomfort, and a sensation of blockage in her left ear. She saw an otolaryngologist at another hospital. On examination, there was maceration, desquamation, and minute hemorrhages on the left tympanic membrane, without perforation. An audiogram reportedly showed conductive hearing loss in the left ear, with a speech-reception threshold of 20 dB.
A tympanogram was flat (indicating decreased mobility of the ear drum, a feature that is consistent with the presence of fluid in the middle ear).The ear canal was irrigated, and a crust was removed from the eardrum. The patient was treated with oral azithromycin and an otic suspension consisting of neomycin, polymyxin B, and hydrocortisone. Symptoms improved briefly but then recurred, with worsening pain, and she came to the emergency department at MEEI.
The patient did not have otorrhea, tinnitus, fever, weight loss, cough, nausea,
vomiting, or abdominal pain. Tests for tuberculosis and the human immunodeficiency
virus had been negative in the past.
患者は耳だれ、耳鳴り、熱、体重の減少、咳、吐き気、嘔吐、腹部の痛みはなかった。結核とヒト免疫不全ウィルスの検査は、過去において陰性であった。
患者は耳漏、耳鳴、発熱、体重減、咳、吐き気、嘔吐もしくは腹痛を訴えてはいなかった。過去に受けた結核、ヒト免疫不全ウイルスのテストは陰性であった。
A diagnosis of essential thrombocythemia
had been made 18 years earlier; treatment had included interferon alfa and
hydroxyurea and had been complicated by anemia that required intermittent transfusions.
She had hypertension, anxiety, chronic diarrhea, and mild renal insufficiency.
Her medications included anagrelide hydrochloride, darbepoetin alfa, and
sertraline. She was allergic to hydroxychloroquine sulfate. She was married, had
worked in a health care facility, and currently worked in an office; she had traveled
to Europe, the Mediterranean, and in the distant past, to China and the Caribbean.
She did not drink alcohol, smoke, or use illicit drugs. .
彼女は高血圧で、不安で、慢性下痢症で、軽い腎臓障害があった。彼女の薬物治療はアナグレリド塩酸塩、ダルベポエチンアルファ、セルトラリンが含まれた。彼女はヒドロキシクロロキンへのアレルギーがあった。彼女は既婚者で、医療施設で働き、現在は事務所にて勤務していた;彼女はヨーロッパ、地中海へ旅行したことがあり、かなり昔に中国、カリブ海へも旅行したことがある。
彼女は飲酒、喫煙、不法ドラッグの使用歴はなかった。
彼女には高血圧、不安神経症、慢性下痢、および軽度の腎機能不全があった。
薬物治療にはアナグレリド塩酸塩、ダルベポエチンアルファおよびセルトラリンが含まれていた。彼女は硫酸ヒドロキシクロロキンにアレルギーを持っていた。既婚者で、ヘルスケア施設で働いた経験を持ち、診察当時は会社に勤めていた。ヨーロッパ、地中海、遠い過去では中国やカリブ海地方への旅の経験があった。
アルコールやタバコ、非合法のドラッグの摂取はなかった。
Her mother had had diabetes
mellitus, hepatic and renal disease, and breast cancer, and her father had had
heart disease and hypertension; her siblings and her child were healthy.
On examination, the blood pressure was 152/72 mm Hg and the other vital
signs were normal. The left auricle was normal. The left ear canal and tympanic membrane were erythematous, and the canal contained white debris; there was a serous effusion in the middle ear. The right ear was normal. The Rinne test revealed better hearing by means of air conduction than by means of bone conduction bilaterally; in the Weber test, sound lateralized to the left. The remainder of the examination was normal.
検査によると、血圧は152/72mm Hgそして、その他の必須の医学的兆候は標準値であった。左の耳介は標準であった。左の外耳孔と鼓膜には紅斑があり、孔内には白い壊死組織片があった;中耳に漿液性滲出液があった。
右耳は標準であった。リンネ検査は骨伝導よりも空気伝道によるほうが両耳ともよく聞こえるとい示した;ウェーバーテストにおいて、音は左に側方化した。残りのテストの結果は正常であった。