Seth Miller is the deaf patient in the episode House Divided.
Medical History Edit
The patient became profoundly deaf at the age of 4, a complication of meningitis. The parts of the brain that receive and process sound are undamaged, but the nerves between the ears and brain were damaged and do not function. The patient is a candidate for a cochlear implant, but has refused to undergo the procedure.
Case History Edit
The patient was admitted when he started having the sensation of hearing explosive noises in his head. Dr. Foreman pointed out the most common causes of this sensation are insomnia, migraines and head trauma. However, the patient had none of these issues. Dr. House believed the patient may have suffered a frontal lobe seizure and directed his team to try to induce another in the seizure lab.
Dr. Hadley and Dr. Foreman performed the procedure to try to induce a seizure. They could not induce a seizure, but the patient lost his vision during the procedure. Dr. Taub believed it might be subclavian steal syndrome a vascular defect combined with arm movement that siphons blood flow from the brain. Dr. Hadley suggested an angiogram and Dr. House agreed. Dr. House later realized the patient's C-reactive protein level was elevated and that the stress of the seizure lab had led to optic neuritis. Dr. House placed a loud boom box on the patient, who then reported he could feel the vibration in his abdomen, but not his hands. This indicated neuropathy. Dr. House had noticed that although the patient had been 15-0 in his matches, he had been pinned in the last three. He believed this indicated his balance was off. Dr. Foreman suggested increased ICP from a brain tumor, but there had been nothing on the patient's head CT Scan. Dr. Hadley suggested rhabdomyolycis from rapid weight loss, but Dr. House noted the patient had actually been gaining weight to reach a new weight class. Given the suggestions, Dr. House believed increased ICP might be correct. He also surmised that his deafness was the result of NF2 and not meningitis. They might have been coincidental and the meningitis would have been the sign of the patient being immunocompromised. Dr. House ordered an MRI. Dr. Taub noted that if Dr. House was right, the deafness could be reversible as NF2 is very slow growing and therefore very treatable. However, although the patient agreed to have the cancer treated, he wanted to remain deaf. However, Dr. Taub noted that the treatment would treat both the cancer and the deafness.
The MRI did show elevated ICP, but no masses on or around the nerves, ruling out cancer. Dr. House noted slight bowing on one of the ventricles which might indicate a tumor. Dr. Taub believed it was congenital. Dr. Hadley noted that a brain biopsy was the only way to tell for sure. However, Dr. House found a three year old MRI from a previous broken nose. Dr. Wilson reviewed it and agreed the bowing was not there three years ago and also agreed the patient needed a brain biopsy. Dr. Chase performed the biopsy and found no indication of increased inflammation from intracranial pressure, ruling out cancer. Dr. House misrepresented to Dr. Chase that the patient also wanted a cochlear implant and Dr. Chase agreed to perform the procedure. Dr. Chase programed the implant and the patient reacted to the noise around him. Although the patient's mother directed Dr. House to remove the implant, he told her it couldn't be done right away. However, he also accused the mother of not really being angry. Dr. Cuddy removed Dr. House as attending and gave the case to Dr. Foreman.
Dr. Taub noted the patient now had a fever, but Dr. Hadley dismissed it as a post-operative complication. Dr. Hadley suggested Arnold-Chiari, but Dr. Foreman noted it would also cause muscle weakness. Dr. Taub suggested pseudotumor cerebri, but Dr. Foreman noted that the patients eyes were normal. Dr. Taub suggested the fever might be the result of the Epstein-Barr virus. This may have caused menigitis leading to the increased intracranial pressure. Dr. House agreed and Dr. Foreman ordered treatment for Epstein-Barr. However, soon after, the patient lost control of his bladder.
The patient was dehydrated, but stable. However, the symptom ruled out Epstein-Barr. Dr. Taub suggested an autoimmune disease, perhaps sarcoidosis. However, Dr. Foreman noted sarcoidosis progresses slowly and the patient's symptoms came on quickly. Dr. Taub suggested pheochromocytoma, but Dr. Hadley noted there was no high blood pressure. However, Dr. House realized the patient had a heart problem. Dr. House asked Dr. Foreman to approve a 12D EKG for four hours. However, it was normal. Dr. Taub thought it might be a thyroid problem and Dr. Hadley suggested Hashimoto's disease. However, Dr. House still believed it was a hidden arrhythmia. He wanted to perform a stress test. However, Dr. Foreman noted that the test could cause a hemmorhage in the patient's brain. Dr. Foreman ordered a thyroid panel.
The patient ripped out his cochlear implant. The stress of the pain showed there was an arrhythmia. Dr. Foreman admitted Dr. House was right about the heart. Dr. Hadley thought it might be thrombocythaemia, a blood disease. However, the patient's platelet count was normal. Dr. Taub thought it might be clotting from a pulmonary embolism. Dr. Foreman suggested a VQ scan to see if the patient's lungs were clear. Dr. House agreed.
However, Dr. House realized that all of the patient's symptoms came about when he was exposed to heat. He informed Dr. Foreman that the patient had Uhthoff's phenomenon, meaning it was multiple sclerosis. Dr. Foreman started the patient on interferon and the patient responded.
However, the patient suffered from lung failure, ruling out MS. The patient was put on a ventilator and had enlarged lymph nodes. Dr. House did not think it was eosinophilic pneumonitis, and Dr. Hadley noted that it also causes problems with the larynx. However, she then realized that because of the patient's speech, they would not notice if his voice was unusually hoarse. However, they tested the patient and realized his larynx was fine. However, when Dr. Foreman went to re-intubate the patient, he noticed tobacco stains on his teeth. He realized that chewing tobacco would mask the symptoms of sarcoidosis as the toxins in the tobacco would suppress his immune system. When the patient quit chewing tobacco, his symptoms came on all at once. They started the patient on corticosteroids and methyltrexate. His mother also insisted that the cochlear implant be repaired.