A Case of Bilateral Sudden Hearing Loss and Tinnitus after Salicylate Intoxication
A 46-year-old female (42 kg) was taken to the emergency unit with her husband. Her mental status was drowsy and she was reported to have taken 200 tablets of aspirin (325 mg×200 tablets=65000 mg) with an alcoholic beverage (soju, alcohol content 19%, 200 mL). A blood sample was taken immediately and showed no abnormality of liver or renal function. The electrolyte profile was also within normal values but arterial blood gas analysis showed metabolic acidosis (pH 7.39, pCO2 33 mm Hg, and bicarbonate 21.7 mmEq/L). Urine chemistry was normal. A nasogastric tube was inserted and activated charcoal and intravenous fluids administered to remove the remaining salicylate in her body. Sodium bicarbonate was used for the correction of metabolic acidosis. She found that her hearing deteriorated and tinnitus developed on the second hospital day, and she was subsequently referred to our department. She was stable in terms of mental status, and her metabolic acidosis was corrected at the time of otologic assessment. Both middle ears were clear in otoscopic views. Neurological examination also revealed no abnormal findings. Pure tone audiometry (PTA) showed bilateral symmetric sensorineural hearing loss with a threshold of 50 dB HL in all frequencies, and tinnitus was equivalent to the narrow-band noise of 4 kHz and 5-10 dB SL bilaterally (). A high-dose oral steroid (prednisolone 60 mg/day) regimen was initiated following medical consultation. Hearing thresholds were unchanged on follow-up PTA and were 60 dB nHL by auditory brainstem response (). Distortion product otoacoustic emission showed no response on both ears (). On the fourth hospital day, PTA thresholds improved to the level of 36 dB HL on both ears () but she refused further admission therapy. She received a daily dose of 60-mg oral prednisolone during the 4 days of admission, which was tapered as scheduled. She revisited the clinic 3 days later and PTA thresholds were normalized to 18 dB HL (). However, she complained that her hearing had not fully recovered and tinnitus remained in the right ear. The tinnitus was equivalent to a pure tone of 125 Hz and 5-10 dB SL in the right ear. Monthly follow-up was scheduled without further medication; she last visited the clinic 4 months after intoxication. PTA thresholds were unchanged and she did not complain of hearing loss or tinnitus.