Odd Symptoms Among Military Members and Family
Michael Hoffer, MD, professor of otolaryngology and neurological surgery at the University of Miami, described his investigation of an odd constellation of symptoms experienced by U.S. military and family members stationed in Havana, Cuba, in 2016 (Laryngoscope Investig Otolaryngol. 2018;4:124-131; https://doi.org/10.1002/lio2.231).
Explore This IssueApril 2020
First one service member, and then many more, reported ear pain, ringing in the ear, dizziness, and cognitive problems. They all experienced a loud noise before and during these symptoms. The sound was localized and, the patients said, it “followed” them around, but would stop immediately if the door to the outside was opened.
When you’re signing up for a revision plugging, you have to indicate to the patient that they may end up with a functional labyrinthectomy at that time, and there is some potential risk to their hearing as well. —Yuri Agrawal, MD, MPH
The 25 people who had exposure and symptoms were evaluated and compared to 10 people who heard no noise and felt no pressure even though they were in the same dwelling at the time. Unaffected Cuban embassy occupants, selected by the embassy, were also evaluated.
Researchers only collected data that was considered relevant after a physical exam. Dr. Hoffer emphasized that the 25 symptomatic patients in this evaluation were evaluated quickly and not influenced by media reports or efforts to get workers’ compensation.
Subjective visual vertical (SVV) tests were abnormal in 88% of the patients. The 12 patients who had vestibular evoked myogenic potential (VEMP) testing had abnormal results on either the cervical or ocular part of the test.
Dr. Hoffer also conducted testing on the eyes’ converging and diverging and observed how the patients’ pupils responded to light. The results, he said, clearly distinguished among normal controls, normal controls with mild traumatic brain injury (TBI), and people affected by the incident in Havana.
“The Havana-affected individuals looked nothing like the TBI subjects, which caused most of the world to shift and say, ‘Well, this is not TBI; this is something different,’” he said.
Researchers are still not sure of the diagnosis. It’s being described as an “acquired neurosensory dysfunction” that universally affects the interpretation of equilibrium and with other vestibular findings (Laryngoscope Investig Otolaryngol. 2018;4:124-131; https://doi.org/10.1002/lio2.231).
The cognitive issues could stem from the vestibular problems, but it’s also possible that the brain itself has been affected, Dr. Hoffer said.
“The site of injury could be the ear alone, or it could be the whole brain,” he said. “But it’s a real physiological disorder in those individuals (who) are truly symptomatic.”