Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Acoustic stimulation tests abnormal, Ataxia, Audiogram abnormal, Balance disorder, Central nervous system lesion
Clinical narrative: Pediatrician:Had covid vaccine Friday 11/5/2021, fine sat/Sunday.  Yesterday after school reported ringing of right ear.  Reporting diminished hearing on right ear.  Today reporting vertigo, dizziness. Reporting feeling like she just got off a merry-go-round.  This morning vomited after breakfast - around 9 am this morning.  Currently doing well at home.  Playing video games.  Still reporting not being able to walk straight.  Asked mother to have patient stand with arms outstretched and close eyes, mother reports she is wobbling when she does this. ER Doctor:12:58 PM. One episode of vomiting.  Zofran ordered. Trial of meclizine ordered.1:28 PM. Discussed with Dr.  (pediatric nephrologist on call) who is concerned about ataxia caused by a cerebellar lesion / infarct. Recommended MRI without / with contrast. 8:12 PM. MRI without abnormal findings. Patient reports feeling much better.Discussed with Dr.  (HNS surgeon on call) who reports that Meniere's virtually never is in children but definitely a vestibular pathology. Recommends referral to their service and course of steroids.  Also review with neurology to see if they want to follow up with her as possible vestibular migraines. ASSESSMENT;1.RIGHT LABYRINTHITIS; 2.RIGHT HEARING LOSS  3.RIGHT SUBJECTIVE TINNITUS; Audiologist; Progress Notes. at 12/1/2021  9:44 AM Status: Signed.  9 year old female seen today for hearing evaluation. Patient accompanied by her mother. Chief Complaint; Patient presents with HEARING LOSS. Reason: vestibular dysfunction, right tinnitus, right hearing loss; Mother reports patient with sudden-onset right hearing loss with tinnitus and vertigo since getting 1st dose of COVID vaccine on 11/05/21. Mother reports patient had no medical issues prior to this. Procedure: Comprehensive Audiometry and Tympanometry; Results:Otoscopic inspection revealed clear external auditory canals bilaterally.Tympanometry: Bilateral normal type A response.Ipsilateral acoustic reflex present at 1 kHz in both ears. DPOAEs (1-8 kHz) with reduced responses in right ear consistent with audio. Inserts; Headphones; Circumaural Headphones; ?Recorded MLV ?SRTs were 5 dB HL in bilateral ear(s), consistent with audiogram.Speech discrimination performance was excellent in right ear(s) at 100 % at an intensity of 45 dB HL.Speech discrimination performance was excellent in left ear at 100 % at an intensity of 40 dB HL.Impression:Right ear-Mild to moderate high-frequency sensorineural hearing loss. Left ear-Normal hearing. Plan: HNS appointment follows today. Recheck post-HNS. Discussed good communication techniques. Preferential classroom seating at school. See audiogram/OAE report in imaging tab. The evaluation results were discussed with the parent, and all questions were answered to the best of my knowledge and scope of practice.  An After Visit Summary was printed and given to the parent. A copy of the audiological results was also provided. Electronically signed by: Audiologist; Department of Head and Neck Surgery/Audiology; 12/1/2021; 9:44 AM; Neurologist; STUDIES REVIEWED Audiogram 12/1/2021; Right ear-Mild to moderate high-frequency sensorineural hearing loss. Left ear-Normal hearing. DPOAEs (1-8 kHz) with reduced responses in right ear consistent with audio. untitled image;ASSESSMENT:1. RIGHT SUDDEN HEARING LOSS; 2.RIGHT SUBJECTIVE TINNITUS ; PLAN/ORDERS: Right sudden SNHL. Recommend high dose prednisone x 2 weeks with taper. Risks, benefits and alternative were reviewed with the patient, including cataracts, worsening glycemic control, infection, blood clots and avascular necrosis. Patient's mother elects to proceed with steroid course. RTC 1 month with repeat audiogram. Orders Placed This Encounter; prednisone (PREDNISONE INTENSOL) 5 mg/mL Oral Conc.