Last week, I saw a very pleasant, intelligent young man referred to me for chronic imbalance and falling. He was a healthy, active man until a mobile home he was working on was struck by lightning several years ago. In addition to numerous other issues, he complained of bothersome bilateral tinnitus, but no appreciable hearing loss. The tinnitus began at the time of the lightning strike, so there was some suspicion that his imbalance may have been the result of a cochlear/vestibular pathology. The lightning exited through his right arm and right foot, leaving some scarring and numbness.
His audiogram showed a 50 dB 2KHz notch, with perfectly normal hearing at 1KHz and below. Speech understanding was normal. His tinnitus was matched at 1.5KHz. Auditory evoked potentials were normal and symmetrical with good wave form morphology.
His vestibular testing, including rotary chair and calorics, was completely normal. His Computerized Platform Posturography was consistent with some mild postural instability, with a pattern suggestive of decreased somatosensory feedback from the lower extremities.
My conclusion was that the tinnitus was most likely a result of noise trauma, and the imbalance related to neuropathy in the right foot. Any other ideas?
For more on otologic injuries related to lightning strike click here.