Journal of the Formosan Medical Association (2019) 118, 647e648

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Correspondence

Cerebral blood flow in a migraine patient

with fluctuated sensorineural hearing loss

Cochlear migraine (CM) is an atypical variant of migraine
presenting with ear symptoms such as fluctuating hearing
loss, tinnitus, and aural fullness.1 Recently, a nationwide
population-based study demonstrated the association of
migraine with cochlear-related disorders.2,3 In this corre-
spondence, we report the case of a patient with migraine
who underwent serial technetium (Tc)-99 m single-photon
emission computed tomography (SPECT) for evaluation of
cerebral blood flow (CBF) during the course of attacks of
fluctuating hearing loss.
The patient was a 40-year-old female who had several
attacks of hemicranias before and was diagnosed as having
migraine without aura based on the criteria of the Inter-
national Headache Society. She visited our clinic with a
chief complaint of right sudden-onset hearing loss and aural
fullness for 3 days without a concurrent headache or ver-
tigo. Her audiogram (Fig. 1A) showed high-frequency
sensorineural hearing loss of >30 dB in 3 consecutive fre-
quencies (4, 6, and 8 kHz) in the right ear. Idiopathic sud-
den sensorineural hearing loss (ISSHL) was diagnosed, and
she received oral medication for treatment. As she feared
that this could be a stroke, she chose to undergo Tc-99 m
SPECT in addition to brain magnetic resonance imaging on
the same day to evaluate the cerebral blood perfusion. Five

Figure 1 A to C. Serial audiograms of the patient during her sudden hearing loss and recovery. D to E. Representing axial sections
of SPECT scan of temporal cortex corresponding to hearing loss episodes and recovery. Arrows points to the increased cerebral
perfusion.

https://doi.org/10.1016/j.jfma.2018.09.020
0929-6646/Copyright ª 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
648 Correspondence

days later, her hearing improved markedly, although not Conflicts of interest
completely (Fig. 1 B). However, another episode of left
sudden hearing loss occurred 1 month later (Fig. 1 C), which None to declare.
is extremely unusual for ISSHL. CM with fluctuating hearing
loss was the most likely diagnosis. She underwent a series of
Tc 99 m SPECT evaluations during the recovery and attack
References
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spread of cortical hyperperfusion followed by gradual
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hypoperfusion in migraine.4 Because her hearing was not aid users. J Formos Med Assoc 2018;117(2):109e16.
recovered after the 3rd attack, she was offered a hearing
aid with function of non-linear frequency compression to
Jen-Tsung Lai
assist daily communication.5 Our study is the first to mea-
Sheng-Kai Huang
sure the serial CBF during the attack and recovery stages in
Department of Otolaryngology, Kuang-Tien General
a case of fluctuating sudden hearing loss without vertigo.
Hospital, Taichung, Taiwan
The results indicate that the patient did not have a stroke
because the cerebral perfusion increased in various parts of Tien-Chen Liu*
the brain. The reversible change in CBF of the affected side Department of Otolaryngology, National Taiwan University
during the hearing loss and recovery was compatible with Hospital, Taipei, Taiwan
the course of a CM attack, which possibly resulted from the
Keh-Bin Wang
neuro-inflammation initiated in the brain and affected the
Department of Radiology and Nuclear Medicine, Kuang-
peripheral auditory system via a top-down mechanism. In
Tien General Hospital, Taichung, Taiwan
summary, the patient was a migraineur with fluctuating
hearing loss but no vertigo. Her dynamic CBF changes
*Corresponding author.
correspond well to those of a migraine in the temporal
E-mail address: liuent@ntu.edu.tw (T.-C. Liu)
lobe, which supports the diagnosis of CM.
20 September 2018