Hearing loss from Ramsey-Hunt syndrome likely is permanent

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DEAR DR. ROACH: Last November, I complained of pain in my right ear. I went to the emergency room and was, oddly, treated for diarrhea. (I will not return to that ER ever again.) A week later, I was struck with Bell’s palsy and was treated at another ER (correctly, per a local ENT doctor). But the Bell’s palsy resulted in 100 percent deafness in my right ear, and I am told that NOTHING can be done for it (no explanation has been offered as to why the deafness). I am writing you to see if there is any way to rid myself of the constant noise in that deaf ear (it sounds like an industrial vacuum or waves pounding against rocks, and at times a trillion katydids). I am getting mighty frustrated. — A.L.

ANSWER: Bell’s palsy is a weakness of the facial nerve on one half of the face. There are many causes of facial weakness, but it is called Bell’s only when no cause can be identified. Most cases of Bell’s palsy are thought to be caused by viral infection, especially viruses in the Herpes family. However, in hindsight, I think it is more likely that you had the related condition Ramsey-Hunt syndrome, in which there is both ear pain and facial paralysis. This is caused by reactivation of the varicella zoster virus, and thus it is a localized form of shingles. Vesicles are sometimes but not always seen in the ear. Some degree of hearing loss is about 50 percent likely in Ramsey-Hunt syndrome, whereas it is rare or nonexistent in Bell’s palsy. Ramsay-Hunt syndrome usually is treated with antiviral medications such as acyclovir, despite a lack of proof that it helps. Unfortunately, the damage done by the virus to the auditory nerve, which is right next to the facial nerve in the brain, is likely to be permanent at this point.

Hearing loss from any cause can lead to the noise sensation you have, which is called tinnitus (tin-EYE-tuss or TIN-a-tuss). There are several possible treatments, none of which is likely to cure the problem entirely but might help to a significant extent. One is a cochlear implant: Studies have shown a reduction in tinnitus in people with hearing loss and severe tinnitus. Tinnitus retraining therapy, cognitive behavioral therapy and biofeedback all are potentially useful tools that are used in specialized tinnitus centers. You find out much more from the American Tinnitus Association at ata.org.

DR. ROACH WRITES: Many people wrote in about their experience with migraine headaches. Certain foods and additives (for example, red wine and tyramine) can be powerful triggers; however, early on in a migraine there can be food cravings, and so the apparent “trigger” may not be (chocolate is a frequent craving early in a migraine).

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Many people also wrote in with alternative treatments to the ones I wrote about. Sphenopalatine ganglion block, a procedure done by neurologists and pain specialists, can be effective, just as the Botox injections I have mentioned previously. Biofeedback techniques, relaxation techniques and a psychotherapy treatment called eye movement desensitization and reprocessing are nonpharmacologic treatments that might help.

I also heard about an informative website at www.migrainedisorders.org that emphasizes the non-headache aspects of migraines.

READERS: The booklet on macular degeneration explains this common eye ailment. Readers can order a copy by writing: Dr. Roach — No. 701, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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