1 Hearing and Vestibular Problem Case Med 6573: Nervous System University of Minnesota Medical School Duluth 16 and 18 February 2005 Drs. Nordehn, Forbes & Fitzakerley Mr. Rodney Mott Chief Complaint: Trouble hearing and problems with dizziness

2 YOU MUST PREPARE PRIOR TO THE SESSION ON WEDNESDAY, 16 FEBRUARY 2005, 11:00 A.M. Review the information provided in this handout relative to: Mr. Mott’s present and past history, meds, allergies and habits. Note significant data. Try to answer the questions that are posed on slide 5. Be prepared to discuss the case.

3 This is the second of three PROBLEM CASES in the Nervous System course. Each will cover content related to the particular part of the course where they are located. Thus, in this first case, the issue is the INNER EAR. Each case is set up to emulate the Clinical Reasoning process in which you first review the History of the patient and then proceed through the Physical Examination, Laboratory and Procedural Findings and Development of a Plan to treat the patient and/or manage their condition. Each case will be presented in two sessions of one hour each. Drs. Nordehn & Forbes will facilitate the discussion of each case with the help of other faculty whose expertise relates to a particular case. For the Inner Ear Case, that faculty member will be Dr. Fitzakerley. Process

4 Mr. Rodney Mott is a 46-year-old carpenter, who has trouble hearing and some problems with dizziness. History of the Present Illness: Mr. Mott noted he was having trouble hearing his teakettle. At times he heard whistling in his ears that was not the teakettle and at other times he could not hear the kettle when it did whistle. This has been going on for several months, getting gradually worse in both ears. One morning, about three months ago, while getting out of bed, he began to hear whistling in his ears that became progressively louder. At the point where it was becoming annoying, he suddenly felt the room begin to spin. He sat down, but this gave him no relief. He became nauseated and eventually vomited. Because the spinning persisted, he climbed back into bed and found himself to be more comfortable when he lay on his right side with his eyes open. Within one half hour the spinning had stopped and the whistling also diminished. Since then, he has had several similar episodes, each beginning with increasing whistling followed by the spinning sensation. Mild hearing problems and whistling in both ears persist but the sounds seem louder in his left ear. Between his attacks he feels quite well and has no difficulty with his strength and coordination.

5 Past Medical History: Usual childhood illnesses. No history of heart disease, diabetes, stroke, convulsions or hypertension. Approximately 5 years ago, he was hospitalized for severe burns on his hands and forearms. He remembers being told that the IV he was given contained antibiotics. He resents the fact that he is still paying for that hospitalization. Three years ago, he suffered a blow to the head while playing volleyball, lost consciousness for a few minutes but was not seen by a physician. He has a history of his hands and feet "feeling puffy", so he has been using his neighbor's furosemide for a couple of years to treat this himself. Habits: Smokes one half pack per day since the age of 20 and has not tried to quit. Drinks one to two beer at dinnertime three to four times per week, but does not drink hard liquor. Does not use street drugs. Social History: Divorced 12 years ago. Works as a carpenter (self-employed). He has one older brother who has had some hearing problems, but he has no details about his brother’s condition. His parents are both alive and have had no serious medical problems. He graduated from high school at age 18, and is happy in his work.

6 What are the important problems that Mr. Mott is having? Be specific. What are the potential causes of these problems? What part(s) of the nervous system is(are) involved and why? What aspects of his history might have contributed to the problems that Mr. Mott is having? What physical exam procedures are you going to perform to test your hypotheses?