Sex: F
Vaccine: VARCEL
Symptoms: Sudden hearing loss, Weber tuning fork test abnormal
Clinical narrative: This spontaneous report as received from a physician refers to a 17 year old female patient, whose case was described in an online article. The patient denied HIV infection, asplenia and medication use at the time of the event. She had no history of past or present immunosuppression. There was no family history of inherited sensorineural hearing loss or gradual hearing loss over time. She denied the use of headphones and had never attended a concert. The patient admitted to listening to music in her car loudly. The patient abstained from alcohol or illicit drugs and had no known drug allergies. The patient was up to date with all state required immunizations. On unknown dates, the patient was vaccinated with 2 doses of varicella virus vaccine live (manufacturer unknown) (dose, route and site of administration, lot # and expiry date were not reported). She did not have chickenpox because she received vaccination. On an unknown date, the patient developed sudden hearing loss in the right ear, along with a burning sensation and a vesicular rash behind the same right ear. She reported acute hearing loss 2 days subsequent to the rash and denied any trauma to head or ear. On an unknown date, the patient and her mother presented to ambulatory acute care. The patient was awake, alert and oriented to person, place, and time. The patient's vital signs were blood pressure, 98/62 (units not provided); heart rate, 86 beats per minute and regular; afebrile; respiratory rate of 16 saturating at 98% on room air. A complete blood count and blood chemistry were done to rule out any immunocompromised state. A Varicella titer was also performed to confirm whether there were any Varicella antibodies indicating immunity to varicella. Objective findings included a 3 cm by 2 cm unilateral, red and raised vesicular rash behind her right ear. Surrounding skin was red and inflamed. Some vesicles were oozing yellow serous fluid from scratching the area. Otoscopic evaluation revealed redness and vesicles inside the right ear canal. There was scant cerumen in both ears. The patient's tympanic membrane was pearly grey with bony landmarks visible. There was no abnormal bone growth seen in the middle ear. A tuning fork was used to perform the Weber hearing test. She was able to feel the vibrations in her left ear, which suggested the possibility of sensorineural hearing lost. The decision to refer the patient to the next level of care was made when vesicles were found inside the ear canal along with hearing loss. The referral was made to try to keep the patient's hearing intact. She was referred to urgent care because Sudden Sensorineural Hearing Loss (SSNHL) is one of the few emergencies in otology. It is a rather common otologic disorder characterized by newly onset unilateral or bilateral hearing loss that develops rapidly, within 72 hours. During a follow up call the next day (date unspecified), it was learned that the patient was diagnosed with herpes zoster. She was diagnosed by clinical presentation alone. A Varicella titer was performed to prove the antibodies of the vaccination were present, which they were not due to varicella vaccination. The patient was placed on VALTREX 1000 mg by mouth 3 times a day for 7 days, TYLENOL WITH CODEINE #3 300mg/30mg every 8 hours as needed for pain, and prednisone (manufacturer unknown), dose pack starting at 60 mg and tapering off over 2 weeks. The patient was given an appointment to follow-up one week after completion of VALTREX with her ear, nose, and throat specialist and instructed to go directly to emergency department (ED) if symptoms worsened. The outcome of the events at the time of the report was unknown. The relatedness between the events and the suspect therapy was not provided. Upon internal review, the event of herpes zoster oticus and sudden sensorineural hearing loss were considered to be medically significant. Additional information has been requested.