"We are healed of a suffering only by expressing it to the full."
-Proust
Years ago, in the ENT Clinic at the County Hospital, I was seeing a new patient. He had been sent to us from another physician with a hastily scribbled consultation note that read “Please evaluate for hearing change.” The patient was nervous but cooperative. His eyes darted around the room, but his gaze never met mine.
“Good afternoon, Mr. Evans! What can I do for you today?”
“My hearing has changed. Something is wrong with it.” His voice was flat.
We talked for a while about his ears. His answers were short. No exposure to loud noises, no drainage, no pain, no ringing, and no episodes of dizziness. He seemed able to hear me just fine as we talked.
“Let me take a look,” I said. I examined his ears. They both looked fine. Very little wax was in the canals, certainly no obstruction. The ear drums looked fine and there was no fluid behind them. I got out my tuning forks and did some basic testing of his hearing. Everything seemed pretty normal.
“Mr. Evans, when did you notice the hearing change?” I asked.
“When they increased my medicine!" he responded. This could be important since some drugs can be very toxic to the hearing and balance mechanisms.
“Which medicine?” I asked. “Who is prescribing it?”
“It’s one of the pills from my psychiatrist, but I don’t know its name!” he responded. As we talked, he was getting more and more agitated.
I couldn’t think of any of the standard psychiatric medications that affect the hearing. I paged through a book which listed common drugs and their side effects and came up empty. I was baffled.
One more try. “Mr. Evans, tell me in what way your hearing has changed since the medication was increased. What exactly is different?” I asked.
His eyes widened and his lip quivered. “I can’t hear the voices anymore!” He started crying uncontrollably. “I can’t hear them telling me what to do!”
We sat there. This was suddenly well outside of my area of expertise. I did my best to calm him and waited for him to regain some of his composure. Before long, I was on the phone, talking to one of my friends in Psychiatry. I later heard that things turned out well.
The following is feedback received for this blog:
Wrong place, but maybe right time/ right doctor. You got him to the right place. :)
- rlbates
http://rlbatesmd.blogspot.com/
