Abstract
A37-year-oldmale was found supine andminimally responsive in his mother’s basement. Emergency medical services reported miotic pupils, bradypnea, and depressed mental status that improved significantly after administration of naloxone 1 mg intramuscularly. In the emergency department, the patient had stable vital signs and normal mental status. He reported having consumed alcohol earlier, then snorting crushed Opana® (oxymorphone: Endo Pharmaceuticals Inc; Chadds Ford, PA, USA) shortly before being found unresponsive. The patient purchased the oxymorphone on the Internet and was unsure if he used the immediateor the extended-release formulation. In the emergency department, the patient felt well, except for acute subjective bilateral hearing loss described as feeling like he was “in a tunnel.” He denied any associated trauma, headaches, changes in vision, tinnitus, or ataxia. His physical examwas unremarkable except for subjective bilateral hearing loss observed by both the patient and the examiners. No formal audiologic testing was performed. What Is the Differential Diagnosis of Sensorineural Hearing Loss?
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