Misplaced Metaphor

Abstract

The informative and well researched article would have benefited from a psychosomatic perspective. Without such a perspective, sudden idiopathic sensorineural hearing loss assumes a status of “the writing on the wall” for the patient because of the uncertain therapeutic options, the high risk of recurrence, or even the risk of stroke. If the author hypothesizes that, pathogenetically, ischemic problems may be implicated, then the importance of a patient’s work stress and social stress in terms of thrombophilic changes has to be pointed out (1–3)—conditions that are responsive to behavioral preventive measures, in contrast to hereditary components. Further, addressing sudden idiopathic sensorineural hearing loss as an indicator of vascular risk without considering the biopsychosocial context is not without its problems. As long as we have to assume heterogeneous and unexplained causes, it does not seem appropriate to counsel patients in this direction. The often heard sentence, “You have an infarction in your inner ear,” is a misplaced metaphor and usually labels a patient as a victim. Where no definite, effective, conventional treatment for sudden idiopathic sensorineural hearing loss exists, tertiary prevention should be considered. Where somatic medicine currently meets its limitations, maldevelopments are common in the shape of dysfunctional attention to the (physical) body, expectations of catastrophic events, and/or active ”doctor shopping.” Patients need good information and a feeling of self efficacy. This is the only way to prevent chronification and decompensation of the symptoms of sudden idiopathic sensorineural hearing loss—such as tinnitus and vertigo—and to avoid social or professional destabilization. Sudden idiopathic sensorineural hearing loss and its sequelae can therefore become a genuine mission for psychosomatic therapy or rehabilitation.