Clinical Snapshot
Initial Diagnosis of Acute Myeloid Leukemia Due to Sudden-Onset Bilateral Hearing Loss
;
A male patient presented due to sudden-onset bilateral hearing loss bordering on deafness, accompanied on the previous day by painless, atraumatic hemorrhage from the right auditory canal, which stopped spontaneously. No tinnitus or vertigo was reported by the patient. During microscopic examination of the ear, a dark-livid discoloration of both eardrums was apparent; the Valsalva maneuver was negative. Audiogram revealed a pre-existing presbycusis and a new-onset bilateral pantonal sound conduction component of up to 50 dB. The tympanogram was flat on both sides. Since hematotympanon was suspected, paracentesis was carried out bilaterally; in addition, tympanostomy tubes were inserted due to pronounced otorrhea (old blood). Postoperatively, the patient’s hearing immediately improved. As a result of the spontaneous hemorrhage of unknown cause, a laboratory investigation was performed in a first step. A differential blood count is a cost-effective and readily available pillar of diagnosis to rule out or confirm the suspicion of malignant degeneration of myeloid or lymphoid leukocytes and—as in this case—is also of considerable prognostic value in cases of spontaneous bleeding. In addition to a general departure from reference values, the patient exhibited marked thrombocytopenia (~ 4000/μL), which is typical of acute myeloid leukemia (AML), and an Hb of 4.1 g/dL. Following the initiation of additional diagnostic tests (bone marrow biopsy, etc.) and a co-assessment by our colleagues in the hematology department, this initial diagnosis of AML prompted the initiation of guideline-based treatment.
Sina Marie Beisel, Prof. Dr. med. Burkard M. Lippert, Hals-Nasen-Ohrenklinik, Plastische Operationen, SLK-Kliniken Heilbronn GmbH, sinamarie.beisel@slk-kliniken.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Beisel SM, Lippert BM: Initial diagnosis of acute myeloid leukemia due to sudden-onset bilateral hearing loss. Dtsch Arztebl Int 2023; 120: 55. DOI: 10.3238/arztebl.m2022.0313
