Need Medical Advice Fast!

[jackh]

I'm an expat living in China. My wife suddenly has lost 100% hearing in her ears AND has such vertigo that she cannot move her head without becoming sick. Came on like a light switch.

I always come to Bangkok for my medical care, but I really have no experience with ear or vastibular nerve issues. Bumrungrad only lists 2 doctors (audiologist) and neither has any credentials listed there. So I need asome forum members to help me out with any experience you may have in this matter.

Time is critical. If this condition continues, she stands a good chance of losing her hearing permanently. I have already wasted 1 week in the Chinese hospital, and they don't have a clue about anything, which is why I never set foot in these places. However my wife was so bad that she crashed (60/30 BP) and at least they got her stabilized and actually feeling good except for the serious ear problem. I just ran home to get on the PC and fire this off hopeful to get some responses here. I am getting her ready to fly out in the next few days, so I need to know where to admit her in BKK quickly.

Please help....thanks

You can direct email me........

Edited December 9, 2009 by jackh

[harrry]

It is quite possible she is unfit to fly and attempting to do so may cause permanant eardamage.

[Sheryl]

Jack, a drop in BP like that suggests more than an ear problem., unloess it was secondary to some medication she was given. What do the doctors think caused it (the hypotension)?

Also on what basis do you assume it is an ear problem as opposed to neurological? Has any ear pathology been demonstrated?

What tests have been doen so far and results?

Sorry to throw so many questions at you but I am not at all sure that she needs an ENT specialists as opposed to something else. Let me know & I'll dowhat I can to assist

[nonthaburial]

Where in China are you, as HK Matilda Hospital might be a better option

[Samuian]

Case of "acute hearing loss" ... not a Doc but can indicate many other issues...

[Sheryl]

PS.

Jack do I understand correctly that she suddenly lost hearing in both ears? As that is quite unusual and would again point perhaps more towards a neurological cause.

And how sudden was sudden?

[Sheryl]

P.P.S.

Assuming it is in fact a bilateral hearing loss:

- how old is your wife?

- had she been ill (cold, flu etc) in say the 2 weeks before this happened?

Any problem with her eyes, either now or before this happened ? (sensitivity to light, tearing etc)

And if you can, find out if she has been tested for (and the results of):

ANA (antinucelar antibody)

C- reactive protein

ESR (sedimentation rate)

As vasculitis is also a possibility....

[Mrjlh]

Try here: http://www.bangkokhospital.com/eng/Bkk_EarNose.aspx

I had a severe ear infection and went here. Outstanding service. Of couse you need to register and work through the their admitting process but once you are seen, they will take good care of you.

[jackh]

Thank you all for the responses. I cannot address each one as my time is limited. I know she has either SHL or VND and need care in this direction. Bangkok will be my destination as I always get the best care there. When I lived in the US, I always come to BKK for medical. So I will not consider another location.

I usually use Bumrungrad, but I don;t think they have a good ear dept from what I see. She has been tested and I have a good idea that she needs ear specialist. Wheather nerve damage, virus or bacterial her condition relates to the inner ear or vastibular nerve. Her BP is a direct result of this sudden onset of extreme vertigo which put her into shock. Her health is excellent. She is very active with sports and otherwise healthy until now.

[Sheryl]

SHL just means "sudden hearing loss", it is a symptom, not a diagnosis. Causes are multiple and include different body systems (brain, autoimmune as well as ENT) so there is no such things as "care in that direction", the direction would be the underlying cause and depending on what that is you might need a neurologist, a reheumatologist, an ENT or a specialist in infectious disease etc.

VND, vestibular nerve disorder, is usually in one ear only, hence my original question as to whether it was both ears, as your post seemed to imply. If so then it is very unlikely to be VND and other causes are more probable. Also, VND would not cause hypotension. Dizziness yes, but hypotensive shock, no. So I am still concerned that there is a more systemic disorder which has not been identified. The reason I harp thisis that different causes require different specialists and hospitals vary in which have the best doctors for different specialities.

Should be aware that vasculitis is comparatively rare in non-Caucasians so the Chinese doctors may not have much exposure to it. And that it is extermely serious and needs immediate aggressive treatment. If the hearing loss is in fact bilateral, please specifically ask them if they have excluded vasculitis.

In the absence of more information and given that you say you are certain she needs an "ear specialist" , that would be an otolaryngologist and all of the major hospitals have quite large departments for this, including Bumrungrad. You had probably looked under "audiology" ratrher than "otolaryngology" and that is where you would have gotten the impression they don't have a large department. They do, although there and at the other hospitals, need to look at sub-specialties as many doctors specialize more in sinus problems/allergy while you would want a specialist in otology, preferrably neuro-otology. At Bumrungrad best bet is Dr. Saowaros Asawavichianginda while at Bangkok Hospital it is Asst. Prof. Dr. Apinan Na Nakorn (specialty in neuro-otology).

Whichever hospital you go to, main problem will be the tendency of specialists to have tunnel vision and overlook causes not related to their own specialty. So you will need to be actively involved in her care and insist on consultations with other relevant specialties, i.e. rheumatology, neurology and infectious disease (assuming she is admitted under the primary care of an otolaryngologist).

Bumrungrad also has the best rheumatologists. However it would not be my first recommendation for neurology; that would be Bangkok Hospital.

Only if the hearing loss is limited to one ear and there is an aletrnative explanation for the hypotensive episode (e.g. reraction to a medication) would I consider VND likely. So I remain concerned that she may be admitted to altogther the wrong service.

In arranging her transfer click on the link for "patient referral" rather than trying to work through the normal phone/email for appointments. And, obviously, bring all test results and a medical summary with you.

Please do not fail to get a rheumatology (to exclude vasculitis & other auto-immune), neurology (to exclude brain lesion) and infectious disease consult if she is admitted to otolaryngology.

[simon43]

Totally OT, but I just want to say that you never fail to come up with professional and sensible medical advice Sheryl

Simon

[elcent]

I had a hearing loss on one ear recently. It affected the ear which suffered three times middle ear infection in childhood. It took seven weeks until it went away. I treated myself with hydrogen peroxyde for cleaning and eardrops.

I have the strange feeling that this this time it has probably something to do with a virus. First there was this immediate hearing loss and after 10 days a light earache started before it subsided after 7 weeks. During this time I also caughed and had light headache/dizzyness.

I do have soft versions of this every year(about the same time) for just one or two days and then it goes away by itself.

Your wife's case seems more serious.

[jackh]

Thanks Sheryl.

She does have loss in 1 ear only. The left ear, which seems typical for VND. It did come on suddenly when she woke up in the morning which also appears to be a common theme with VND. I and booked her into BNH to see an otolaryngologist, Dr. Chanchai Charakorn. Well will leave Mon morning from China. I will certainly be most proactive in her care. While I normally use Bumrungrad, I decided to go to BNH because I have a condo only a few blocks away from there.

I will want to know weather it is viral, bacterial or vestibular in origin. Then I also have an idea of how this is usually treated. I have all reports in hand, and even had a CT of her neck done as well. Lucky for me I have contacts with Chinese immigration which will get her out of China without first having a Thai visa. That process takes 2-3 days in Kunming. Her "golden hour" is fast running out now.

BTW, Merry Christmas to all.

[Sheryl]

OK if one ear only the indeed VND likely. Your first post said "ears" plural hence my concern.

The hypotensive episode remains an outlier but my guess is that it was due to a medication she was given or interaction of more than one medication. Would be worth knowing which one(s) for future reference especially if it was an allergic reaction.

Good luck

[Bizz]

SHL just means "sudden hearing loss", it is a symptom, not a diagnosis. Causes are multiple and include different body systems (brain, autoimmune as well as ENT) so there is no such things as "care in that direction", the direction would be the underlying cause and depending on what that is you might need a neurologist, a reheumatologist, an ENT or a specialist in infectious disease etc.

VND, vestibular nerve disorder, is usually in one ear only, hence my original question as to whether it was both ears, as your post seemed to imply. If so then it is very unlikely to be VND and other causes are more probable. Also, VND would not cause hypotension. Dizziness yes, but hypotensive shock, no. So I am still concerned that there is a more systemic disorder which has not been identified. The reason I harp thisis that different causes require different specialists and hospitals vary in which have the best doctors for different specialities.

Should be aware that vasculitis is comparatively rare in non-Caucasians so the Chinese doctors may not have much exposure to it. And that it is extermely serious and needs immediate aggressive treatment. If the hearing loss is in fact bilateral, please specifically ask them if they have excluded vasculitis.

In the absence of more information and given that you say you are certain she needs an "ear specialist" , that would be an otolaryngologist and all of the major hospitals have quite large departments for this, including Bumrungrad. You had probably looked under "audiology" ratrher than "otolaryngology" and that is where you would have gotten the impression they don't have a large department. They do, although there and at the other hospitals, need to look at sub-specialties as many doctors specialize more in sinus problems/allergy while you would want a specialist in otology, preferrably neuro-otology. At Bumrungrad best bet is Dr. Saowaros Asawavichianginda while at Bangkok Hospital it is Asst. Prof. Dr. Apinan Na Nakorn (specialty in neuro-otology).

Whichever hospital you go to, main problem will be the tendency of specialists to have tunnel vision and overlook causes not related to their own specialty. So you will need to be actively involved in her care and insist on consultations with other relevant specialties, i.e. rheumatology, neurology and infectious disease (assuming she is admitted under the primary care of an otolaryngologist).

Bumrungrad also has the best rheumatologists. However it would not be my first recommendation for neurology; that would be Bangkok Hospital.

Only if the hearing loss is limited to one ear and there is an aletrnative explanation for the hypotensive episode (e.g. reraction to a medication) would I consider VND likely. So I remain concerned that she may be admitted to altogther the wrong service.

In arranging her transfer click on the link for "patient referral" rather than trying to work through the normal phone/email for appointments. And, obviously, bring all test results and a medical summary with you.

Please do not fail to get a rheumatology (to exclude vasculitis & other auto-immune), neurology (to exclude brain lesion) and infectious disease consult if she is admitted to otolaryngology.

Totally OT, but I just want to say that you never fail to come up with professional and sensible medical advice Sheryl

Simon

OK if one ear only the indeed VND likely. Your first post said "ears" plural hence my concern.

The hypotensive episode remains an outlier but my guess is that it was due to a medication she was given or interaction of more than one medication. Would be worth knowing which one(s) for future reference especially if it was an allergic reaction.

Good luck

you are a life giver to us all Sheryl we are all thankful for you being there in times of crisis

[dr_Pat_Pong]

Credit where credit is due Sheryl. Good upon you.

[Sheryl]

Happy to do what I can.

Jackh, please let us know how this turns out, we are all rooting for you.

[jackh]

Happy to do what I can.

Jackh, please let us know how this turns out, we are all rooting for you.

We arrived at BNH Monday. Dr tested and said she has ISSH. He is 90% certain it is viral and her vestibular nerve is ok (not VND). He put on predisone, 60mg and tomorrow we go for another test to see if this is improving her condition. This is day 3 now and she already has noticable improvement in relation to the vertigo. She can walk around unaided, and is only mildly dizzy, but still cannot hear from 1 ear. We've been out eating great Thai food and trying to enjoy our stay anyway.

It is not possible this happened from some drug reaction. She took no drugs before this. It just came on without warning.

BTW, I was trying to get predisone for her while we were in China. I was going to give her 60mg per day, exactly what this doctor did! I couldn't get it in China, otherwise she would have started it within 4 days of her contraction. I am dam_n upset I could not get this in China. Now it might already be too late for her to regain her hearing.

I heard there is a new location for the Thai Embassy somewhere. I will need to go there and get her visa extended since I had to get her a visa on arrival when we landed here. I will get a letter from the doc which will allow her an extension. A VOA is only extend able under medical issues. How would I best get there using BTS?

[powderpuff]

New Imm Office

[powderpuff]

IMM Moves

[LaoPo]

Happy to do what I can.

Jackh, please let us know how this turns out, we are all rooting for you.

We arrived at BNH Monday. Dr tested and said she has ISSH. He is 90% certain it is viral and her vestibular nerve is ok (not VND). He put on predisone, 60mg and tomorrow we go for another test to see if this is improving her condition. This is day 3 now and she already has noticable improvement in relation to the vertigo. She can walk around unaided, and is only mildly dizzy, but still cannot hear from 1 ear. We've been out eating great Thai food and trying to enjoy our stay anyway.

It is not possible this happened from some drug reaction. She took no drugs before this. It just came on without warning.

BTW, I was trying to get predisone for her while we were in China. I was going to give her 60mg per day, exactly what this doctor did! I couldn't get it in China, otherwise she would have started it within 4 days of her contraction. I am dam_n upset I could not get this in China. Now it might already be too late for her to regain her hearing.

I heard there is a new location for the Thai Embassy somewhere. I will need to go there and get her visa extended since I had to get her a visa on arrival when we landed here. I will get a letter from the doc which will allow her an extension. A VOA is only extend able under medical issues. How would I best get there using BTS?

Predisone is a common misspelling and misunderstanding for Prednisone but Prednisone is widely available all over China but by prescription only (but in some pharmacies you would have been able to get it straight away!) In Chinese: 强的松 or: Qiang Di Song; if you would only have known you would have got it immediately.

Which city or area were you in China and which hospital did you go to? There are a few very experienced China expats on this forum and I'm surprised nobody stepped in to help you.

I'm sorry I didn't read your OP until just now; my wife would have been able to arrange/help something for you whilst you were there.

Hope your wife recovers fast and good luck!

LaoPo

[Sheryl]

Jack, posters above have provided address of immigration. By BTS go to Morchit and then take a cab.

BTW my reference to drug reaction meant the hypotensive episode in hospital, not the hearing loss.

In some cases of sensorineural hearing loss cochlear implants are effective.

[jackh]

LaoPo, We are from Kunming. The doctor there tells us my wife will never recover, but 10 days in the hospital there would be good for her. I ask what is her trouble and they say they do not know. However they can tell us she will not recover. Of course I quickly move to get her out of China and into Thailand to get some real help.

Thank you for your response. We will see another specialist today and know more of what her outcome will be. She is 1 week now on the Prednisone and this has at least greatly reduced the vertigo. She is able to walk and function normally, but still a little dizzy and also no hearing in her ear.

I will go to the visa place here and get her visa extended next week.

Merry Christmas