History:

Age: 78

Gender: Female

She states “I started having problems hearing just about when I retired, and my loss is getting worse each year.”  She wears hearing aids the fill the entire ear; they are this style.

• What is this style of hearing aid called?

The patient complains that she has to frequently adjust the hearing aid volume, has trouble knowing if the volume is “up in each ear” and says she does not hear as clearly as she would like.  She particularly complains about understanding dinner companions when she eats out. The audiologist specifically asked about the sound levels during dinner.  The patient tends to eat early at times when the restaurants are not too crowded. She dines with five or six friends about twice a week.

She does not report any aural pain or fullness. She has some dizziness which she says is more like an unsteady feeling rather than a spinning feeling. She says if she gets up quickly, she’s likely to be unsteady. She also says she feels “lightheaded” at times. She hears a ringing sound in her ears, but she says it doesn’t really bother her; she’s “quite use to it by now.”

Her medical history includes atrial fibrillation, treated by Toprol 50 mg ER and Betapace.

Dizziness can come from inner ear problems but can also come from medications.

• What is atrial fibrillation?
• Search for websites that describe side effects from medications.  Is it possible that either the Toprol or the Betapace could be causing her type of dizziness?
• What is “true vertigo” – do her complaints sound like vertigo?

Otoscopic examination showed clear ear canals with minimal cerumen.  The cone of light was visible in each ear.