Working Diagnosis:
Enlarged vestibular aqueducts (EVA) resulting in sudden sensorineural hearing loss

Treatment:
<a href="CaseStudyImages/CS2CS1HeadingTowardH-1395.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> <br>The patient completed the course of prednisone as directed by ENT. Compared to initial testing, audiometry testing two weeks later showed improvement in the right ear, with better low-frequency thresholds (from 55-90 dB HL to 25-80 dB HL) and markedly improved speech discrimination (from 56% to 88%). Overall, findings indicate partial recovery of auditory function in the right ear and stable sensorineural hearing loss in the left ear. She was prescribed hearing aids for daily use.

Outcome:
After shared decision making, the athlete was medically cleared to play. She verbalized understanding that head trauma, including heading the ball, carried a risk of permanent hearing loss but desired to continue playing. Despite medical clearance, she was withheld from competition for the remainder of the season by her coaches due to concerns she would be less effective if she avoided headers.

Author's Comments:
Non-disclosure of accurate medical history complicates risk assessment and medical decision making for both the athlete and care team. Beyond history-taking, an athletic care team should foster an environment where athletes feel comfortable disclosing medical conditions. There should be clear communication that disclosure will not automatically exclude participation, and reassurance that the shared goal is to optimize safety while supporting athletic goals. There is no agreed upon way to screen for hearing loss during a preparticipation physical evaluation, but this should be an essential part of the initial athlete screening process and intake exam.

Editor's Comments:
Enlarged vestibular aqueducts are the most common inner ear malformation that are associated with sensorineural hearing loss. A vestibular aqueduct is considered enlarged if it is larger than one millimeter. One known cause of enlarged vestibular aqueducts is a mutation in the SLC26A4 gene, which can lead to Pendred syndrome. Some studies suggest that head trauma can potentially lead to progression of hearing loss. <br> <br>Athletes with enlarged vestibular aqueducts who participate in contact or collision sports may therefore face unique considerations regarding continued participation given the potential aspects and impact on auditory function. While routine hearing screening is not universally incorporated into preparticipation physical evaluations, targeted questioning regarding hearing changes, tinnitus, and prior otologic diagnoses may help identify athletes at increased risk. <br> <br>Although recommendations regarding sports participation in athletes with enlarged vestibular aqueducts are not uniformly established, individualized counseling regarding the potential risk of progressive or permanent hearing loss is important. Management of athletes with underlying otologic conditions may benefit from multidisciplinary collaboration among sports medicine physicians, athletic trainers, otolaryngologists, audiologists, athletes, and coaching staff. <br> <br>This case emphasizes the importance of clearly communicating both known and uncertain risks while incorporating an athlete's goals and values into participation decisions. In addition to highlighting the importance of being thorough in taking a medical history for athletes, it also demonstrates the value in building a foundation and culture of trust that supports and encourages athletes to be honest and open with providers.

References:
Abe, S., Usami, S., Hoover, D. M., Cohn, E., Shinkawa, H., & Kimberling, W. J. (1999). Fluctuating sensorineural hearing loss associated with enlarged vestibular aqueduct maps to 7q31, the region containing the Pendred gene. American Journal of Medical Genetics, 82, 322-328. PubMed ID: 10051166. <br> <br>Alemi AS, Chan DK. Progressive Hearing Loss and Head Trauma in Enlarged Vestibular Aqueduct: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2015 Oct;153(4):512-7. doi: 10.1177/0194599815596343. Epub 2015 Jul 23. PMID: 26204902. <br> <br>Wang H, Wu X, Guan J, Zhang J, Wang D, Wang Q. [Clinical characteristics and analysis of drug treatment efficacy in hospitalized patients with sudden hearing loss due to enlarged vestibular aqueduct syndrome]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar;39(3):233-238. Chinese. doi: 10.13201/j.issn.2096-7993.2025.03.009. PMID: 40049639; PMCID: PMC12361096.

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