Dr. Roach

Dr. Keith Roach00

DEAR DR. ROACH: I recently had a scary episode. According to my family members, for a period of four hours or so, I repeated questions that I should’ve known over and over again. I seemed confused. I did not remember anything; I just said them repeatedly. There was no other neurological changes or stroke symptoms.
I have been under a lot of stress and strain with family issues. After four-and-a-half hours, I became clearheaded again. I did have a slight headache and fogginess for a time after the episode. I am 72 years old.
After seeing my internist, and all the tests came out clear, my final diagnosis was transient global amnesia (TGA). Can you give any information about this condition and what to possibly expect in the future? — C.P.
ANSWER: TGA is a terrifying experience for families. It is most common in people in their 60s and typically lasts about six hours. During this period of time, a person cannot make new memories, so they cannot recall the answers to the questions that they keep asking. (It’s sometimes called the “broken record” effect.)
Headaches are common, but as you say, there are no other neurological symptoms or physical exam findings to suggest a stroke. People with TGA are not at a higher risk for stroke. The emotional stress that you note is a common finding in people who develop this uncommon problem (one person out of 1,000 per year).
Fortunately, the prognosis after TGA is very good. Most cases do not recur.
DEAR DR. ROACH: Have you ever heard of a stapedectomy? I’ve had hearing loss for many years, but I totally lost my hearing about two years ago. It could not be determined why, but a stapedectomy was recommended. I had the surgery, and my hearing is so much better.
I am tempted to have it done to the other ear so that, possibly, I would not need hearing aids at all. It does not cover nerve damage, but conductive damage is often greatly helped by this. You may want to check this out. I had to ask about it because nobody suggested it to me. Without it, I would have been deaf in one ear. — P.H.
ANSWER: I have never had a patient undergo stapedectomy. As you correctly say, it is not appropriate for people with hearing loss due to nerve damage, whether through loud noise exposure or the common hearing loss that occurs with age.
It is effective in people with otosclerosis, where the tiny bones in the middle ear fuse and can no longer transmit sound to the inner ear. More than 3 million people in North America have otosclerosis, and it often shows up between ages 20 and 45.
Hearing aids remain a valid treatment for many people with otosclerosis, but an alternative is the surgical procedure of a stapedectomy, which includes removing a portion of the stapes. (Sound is transmitted from the eardrum to the malleus, to the incus and finally to the stapes.) A piston prosthesis then takes the place of the removed stapes.
More than 90% of people receive hearing improvement from a stapedectomy.
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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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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