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A 33-year-old man presented with sudden-onset unsteadiness, oscillopsia, nausea and vomiting, and left ear tinnitus and hearing loss. One month prior, he had developed lethargy and epigastric and thoracic back pain. Liver function tests were abnormal with a mixed hepatitic and obstructive picture. The nausea and vomiting settled, but 5 days after the development of the vestibulocochlear symptoms, he woke up with painful red eyes which resolved within 24 h. Over the following 2 weeks, the patient noticed a deterioration in hearing with probable complete loss in the left ear, a reduction in the right and bilateral tinnitus.
He had no significant medical history and was taking no regular medications or recreational drugs.
Examination indicated …