A couple of weeks ago I attended a meeting with a customer, who is in her 30s, at her GP practice, she had made a complaint to them regarding her misdiagnosis and subsequent treatment of sudden hearing loss. As a consequence of the misdiagnosis and lack of knowledge by all GPs at her practice she wasn’t referred urgently to ENT and given the intratympanic steroids that could have saved her hearing. The meeting was very open and honest and the 3 senior GPs in attendance apologised profusely and admitted that they had never heard of the intratympanic steroid being used as a treatment for sudden hearing loss?
This is the time line of her symptoms and experience with her GP practice as she tried to get the referral and treatment she needed from ENT:
8th August- 1st doctor’s visit:
Symptoms: Started on 1st August with hearing loss in right ear, followed by dizziness and then nausea – all occurring for a couple of hours each day.
Diagnosis: Blocked Eustachian tube. Doctor saw a couple of small bubbles behind the eardrum, which could indicate possible congestion (although no history of head cold/allergies). No obvious sign of any external problems (no pain, no discharge, no swelling or blockage). Advised to try popping ears to clear any congestion.
23rd August – 2nd doctor’s visit:
Symptoms: Since last appointment symptoms of hearing loss, followed by dizziness, nausea and loud ringing in ear had gotten worse, and were lasting for 24 hrs, before going away. These symptoms had then worsened further and by the time of this visit I had had constant hearing loss for 4 days, as well as worsening dizziness and vomiting.
Diagnosis: Blocked Eustachian tube. Ear examined again where doctor’s observations were same as on previous visit. Doctor recommended to start taking decongestant tablets and try popping ears to clear any congestion.
3rd September – 3rd doctor’s visit:
Symptoms: Nausea and dizziness had gone but hearing loss in right ear remained constant (constant hearing loss for 2 weeks now) and constant ringing noise had been replaced with a constant static noise. Told doctor that I had noticed I couldn’t hear anything in my right ear when I had headphones on.
Diagnosis: Ear examined again; no sign of small bubbles seen by previous two doctors and no sign of any cause of the hearing loss. Doctor tested hearing by whispering in each ear, which confirmed hearing loss in right ear. Prescribed Beconase Nasal Decongestant Spray instead of the decongestant tablets, to clear any congestion. Follow up appointment made for 1 month and routine referral made to ENT (doctor said wait time would be ~3 months).
13th September – Hearing test at Bryce Hearing Services:
Audiogram results revealed profound hearing loss in right ear. After 3.5 weeks since hearing loss, the damage was probably permanent but there could still be a slight chance of some improvement with steroid injections into the ear drum, which needed to be done urgently.
13th September – 4th doctor visit (phone call):
After hearing test I phoned and explained the results to the on-call doctor at my GP practice who said that she had no knowledge of steroid treatment for hearing loss and all she could do was make a record of my audiogram results in my notes. I told her that a professional audiologist had advised that steroid treatment was the only possible chance of salvaging any of my hearing and should be treated as an emergency, but I made no progress with this doctor.
14th September – Visit to A&E at ARI:
As I had made no progress with steroid treatment from my doctor’s, I went to A&E to ask for steroid injections and showed them my audiogram results. A&E turned me away because my hearing loss hadn’t just happened that day. They told me to go back to my GPs again and ask for the steroid treatment.
14th September – 5th doctor visit (phone call):
Phoned my doctors again and asked to speak to a senior doctor. This doctor also told me that she was unaware of steroid treatment for hearing loss but contacted the on-call ENT consultant who confirmed the use of steroids to treat hearing loss and I was prescribed a course of oral Prednisolone and told I would get a letter for a follow up appointment with ENT after the steroid treatment.
2nd & 3rd October – Visit to ENT consultant (Mr Ram) at Albyn:
After I had finished the oral steroid treatment I hadn’t received any letter from the NHS for a follow up appointment with ENT. I phoned to ask about my appointment and was told that I was still on the general ENT referral waiting list, which would have meant waiting for 2 more months. I said that I thought I should have been moved to the urgent list and was told the wait time was still 6 weeks. I still wanted to try the steroid injections and thought that 6 weeks was too long to wait so made an appointment privately at Albyn with Mr Ram, he said that he was sorry that I hadn’t been able to see him sooner and that he would give me the steroid injections the following day for free on the NHS.
15th October – 2nd Hearing test at Bryce Hearing Services:
Two weeks after steroid injections there was no improvement in hearing in right ear.
16th October – Follow up visit with Mr Ram at Albyn:
Since there had been no improvement in my hearing after the steroid treatment I was referred for hearing aids on the NHS. Mr Ram fast-tracked me through audiology and I got my hearing aids from the NHS a few weeks later.