In the spring of 1995, two patients with unusual symptoms taught me a critical lesson.
The first patient, a 50-year-old man, came into my office with what I could only describe as a peculiar set of symptoms. When he sang in the shower, everything he saw would begin to move about in a predictable pattern. He had also noticed that if he hummed or heard certain loud noises while looking in the mirror, he saw his eyes move in response. He even demonstrated this for me, and we worked with a recording device until we could replicate his symptoms.
It was a puzzle. The patient was convinced he had multiple sclerosis or a neurological disorder. He’d been sent to a psychologist and told he was imagining these sights.
Two weeks later, a second patient came to me with remarkably similar symptoms, and the added challenge of disequilibrium.
I’d started to develop a theory while closely examining the first patient. After studying and listening for some time, watching his eye movements respond to sound, I noticed something. His eyes moved in the same direction every time — upwards and counterclockwise, and always closely linked to the sounds he was hearing. The direction repeated with patient two. This made me suspect that the source of the problem was the superior semicircular canal, a key part of the inner ear that we use to maintain balance, perceive motion, and determine spatial orientation. A hole in the canal would explain both the symptoms and the eye movement.
To test the theory, my team and I worked with a neuroradiologist to develop the CT scan methods required to identify a tiny hole. We scanned the patients, and, sure enough, they both had a hole in the bone covering the superior semicircular canal. We’d identified the source of the patients’ problems, and discovered a new disorder that I named superior semicircular canal dehiscence (SCDS).
Of course, identifying a problem only goes so far without finding a solution. Over the following year, we developed a surgical approach for correcting SCDS, plugging the hole in the canal with fascia and bone. As of today, hundreds of patients have had holes in the superior semicircular canal plugged.
One of the most valuable lessons I learned from this experience is the importance of listening closely to my patients. If I hadn’t been ready and willing to engage with these two patients and hear them when they described their vague and unusual symptoms to me, I wouldn’t have been able to help them — or hundreds of others since.
The high-tech aspect of medicine is developing at an impressive pace — we’re learning new ways to deploy technology at the bedside every day. But high touch is just as important. Truly listening to your patients is among my mostly deeply held beliefs, and one that I try to pass on to every medical student I meet. Above all, it’s just good medicine.
Photo by Hush Naidoo