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Boyle KL, Rosenbaum CD. 
“Oxymorphone insufflation associated with acute sensorineural hearing loss: case files of the University of Massachusetts medical toxicology fellowship”. 
J Med Toxicol. 2013 Jun 20;9(2):179-83.
Case Presentation

A 37-year-old male was found supine and minimally 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 immediate- or 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 exam was 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?

The differential diagnosis of sensorineural hearing loss (see Table 1) is extensive and includes medications, organic solvents, heavy metals, structural lesions, neurologic disease, infectious etiologies, psychiatric disease, and trauma, and it can be idiopathic [1–3]. Noise exposure is recognized as one of the most common causes of hearing loss, affecting both people exposed to loud environments on a regular basis, as well as singular exposures like gunshots [4]. Acoustic trauma causes damage to the middle and inner ear and is often permanent.
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