Catherine Nettles Cutter, a professor at Penn State University, vividly recalls two years of her life spent trying to recover from a bodysurfing accident that resulted in the mysterious loss of her voice. After being examined by dozens of doctors, it was evident that she was not going to receive a definitive diagnosis.
A recent article in the Washington Post describes her search for answers to symptoms few doctors were able to explain.
The only solution to recover her voice seemed to be surgery. It was performed in 2010 with acceptable results.
Now Catherine is facing another “unknown.” In this case, the injury seemed to have happened during a regular massage session. As the masseuse turned Catherine’s head to either side, Catherine could hear a loud ‘crack’. The masseuse was aware of it and casually mention to Catherine that she might want to see a physical therapist to gain better flexibility.
Catherine left the massage session without further signs or discomfort. But the next morning she experienced a severe case of vertigo. Catherine assumed that pressure from the migraines she has endured for years triggered her vertigo.
Her husband drove her to a local clinic where the nurse suggested that her problem might be benign paroxysmal positional vertigo. The disorder is the result of an imbalance in the inner ear. Labyrinthitis, which is an inner ear infection, was also suggested as a possibility.
The following day Christine’s symptoms worsened. Her husband called the clinic, and the nurse told him that Christine may be experiencing a stroke. She advised him to take her to the hospital immediately.
After blood tests and a CT scan, the examining physicians felt confident that it was not a stroke. They prescribed medicine for her unusually high blood pressure. It was their opinion also that Catherine’s symptoms were caused by labyrinthitis.
Although her vertigo began to subside, Catherine was left with a ninety percent hearing loss in her right ear. She went to a physical therapist for a treatment called Epley maneuver for positional vertigo.
The doctor started steroid injections in the ear hoping to improve her hearing. Catherine also began a therapy called vestibular rehabilitation to reduce vertigo but nothing helped.
Catherine’s ear, nose, and throat specialist was of the opinion that it might be Ménière’s disease. Ménière’s is a type of rare inner ear disease causing severe dizziness. Catherine was referred to a neurotologist, who specializes in areas of the nervous system and the brain.
By that time Catherine began to worry about her ability to teach. She also had to endure the constant, disturbing sounds of tinnitus.
Catherine tried to alert the examining doctors to her problems after her surfing accident, but they continued to focus on her pain without regard to the accident.
Could It Be Eagle Syndrome?
Then her surgeons at Penn found that she had a rare disorder called Eagle syndrome. The disorder occurs as a result of a pointy bone in the skull that extends to the ear and presses on a nerve.
Now the physicians focused on her surfing accident, suggesting that the injury encouraged bone growth. The pain issues were resolved and her voice was restored by snipping off the excess bone.
Catherine’s next appointment was with a neurologist in Philadelphia. The doctor suggested an implantable hearing device. Catherine agreed and received a bone-anchored hearing aid that treats a single-sided loss of hearing.
While still struggling with vertigo, Catherine discovered different sensations each time she changed positions. It seemed that vertigo surfaced immediately upon turning her head while lying on her back. Then the vertigo subsided when she would lay on her left side.
That convinced her that the neck was in some way the cause of her problems and led her back to the massage as the key.
Again, however, her medical advisors disagreed about the cause of her sensorineural loss of hearing or attached any relevance to her massage as the cause of her symptoms.
After three doctors gave three different diagnoses, Catherine was referred to Dr. Choudhri, who is the director of the cerebral revascularization at Penn Center.
Fortunately, Christine was able to get an appointment with Dr. Choudhri on March 9th of 2020, just before the entire country was shut down by the pandemic
About Bow Hunter’s Syndrome
After reviewing Christine’s workups Dr. Choudhri told her that he believes she has a rare condition called rotational vertebral artery syndrome, also known as bow hunter’s syndrome. The disorder received the name because it results from neck and head-turning when lining up to shoot.
His diagnosis was confirmed using a dynamic cerebral angiogram that tracks blood flow in the brain. The neck is generally stationary during imaging and the only way to reveal it is by dynamic angiogram
Dr. Choudhri explained that Catherine’s condition was caused by a bony overgrowth called Eagle syndrome. The doctor said that in fifteen years of practice he has only seen ten cases.
Surgical positioning, chiropractic manipulation, and several sports head the list of known causes.
Dr. Choudhri went a step further by discussing the relationship of Catherine’s massage to her symptoms. He believes that the bone spur made contact with the vertebral artery during the massage. He recommended removing the bone spur and fusing two of her vertebrae.
The surgery was scheduled three months later due to the pandemic. A stroke is always possible in cases of bow hunter’s syndrome so the waiting period was very stressful for Catherine.
Finally, in June of 2020, the surgery went forward and was successful. However, the vertigo was not substantially reduced nor had her hearing improved.
And Now a Cochlear Implant
Her doctor removed Catherine’s hearing aid and replaced it with a cochlear implant in March 2021. The cochlear is a small implanted device for severe hearing loss.
This time Catherine’s hearing improved, and even her tinnitus that had been plaguing her for years had diminished.
Despite various opinions from a long list of doctors, Catherine had not been told of the reason for her severe loss of hearing. Her audiologist pointed to the massage as causing blockage of blood flow to the hair cells in her ear. He said that cases of a sudden loss of hearing have occurred after manipulating the neck.
It is now nine months after her cochlear implant. Catherine is pleased to report that her vertigo is now at levels she considers manageable.
Catherine acknowledges that she will no longer submit to a massage. She is philosophical about her illness saying that it could have been a worse scenario such as a cracked neck.