While riding on a golfcart after covering the US Open last week, ESPN sportscaster Sean McDonough spoke to me by phone about his own encounter with a putter that set off series of health problems that will require surgery, planned for August: “Somehow, the front of the putter hit me in back of the head when I was picking it up,” he said of an incident that took place in February. “It didn’t hurt that much or leave a bump, but immediately I heard a kind of loud, squealing in my left ear that went down to dull seashell noise; it’s remained constant ever since.”
It turned out to be a rare condition called superior canal dehiscence syndrome, which is caused by a tiny pin-prick-size hole in the inner ear bone. “Your brain actually pulsates and, like an eraser, it rubs up against this bone, thinning it out over time,” said Dr. Daniel Lee, an ear and skull base surgeon at Massachusetts Eye and Ear Infirmary who will be performing McDonough’s surgery. Likely, McDonough’s ear bone had already thinned extensively before the bonk on the head with his club caused a hole to form.
While an estimated 2 percent of people have a hole in this bone, only a fraction of those develop telltale problems like dizziness, tinnitus, a sensation of having a blocked ear, or hearing the body’s internal functions such as a thudding heartbeat, moving eyeballs, or the echoing of speech.
“I’ve had a patient who said a plate crashing in a restaurant triggered symptoms,” said Lee. Two others developed symptoms after childbirth. Sometimes the condition, abbreviated SCDS, can be triggered by blowing one’s nose hard if the bone is thin enough already.
What’s fascinating is that this condition was first identified only 14 years ago by an otolaryngologist at Johns Hopkins -- whom Lee trained with -- who had the brilliance to link the weird array of symptoms to the tiny inner ear bone and the good fortune to find a radiologist able to use a highly specialized CT scanner to image the bone, which rests near the skull.
Before then, patients were often told they were crazy when they reported hearing weird sounds in their head or were diagnosed with unexplained vertigo or tinnitus.
Even now, many of the more than 200 patients Lee has helped diagnose were originally misdiagnosed by their primary care doctors and came across SCDS after searching on the Internet for causes of their symptoms.
Only about a third of those Lee diagnoses, he said, end up needing surgery to plug up the hole in the bone. Some have mild symptoms that can be managed with medications to alleviate the dizziness or with ear plugs if they’re sensitive to external loud noises. (Ear plugs, unfortunately, won’t help quiet those internal sounds of a pulse or eye motions.)
McDonough has opted for surgery that will require removing a piece of his skull and lifting his brain to reach the bone in his left inner ear. Sometimes the surgery can be performed by entering through the ear itself, said Lee, but that depends on the location of the hole and where the brain sits within the skull. Both techniques, he added, are “generally safe” but cause some degree of prolonged dizziness after the surgery, which lasts one to three months.
Those who have a history of migraines or have earbone holes in both ears have a greater risk of having dizziness that lasts more than three months. In rare cases, the procedure can cause hearing loss or seizures, but Lee said he’s so far had “no major issues” with his surgeries.
“I went online and watched a video of the surgery and kind of wished I didn’t,” said McDonough. “But I’ve been told Dr. Lee is the best, and I’m only 50 and otherwise in great health, so I’m hoping all these aggravating things will be reversed by the surgery.”
He added that he was gratified that the publicity over his condition, including an article in USA Today, has helped increase awareness. “I’ve already heard from a couple of people who said they’ve had the same symptoms for a long time and didn’t realize what they could be.”