A common occurrence—a child kissing her mother—led to a somewhat rare syndrome that Levi Reiter, head of the audiology program at Hofstra University (Hempstead, N.Y.) is compiling into a journal article to be published this month.
The syndrome, becoming known as "REKS" (Reiter's Ear-Kiss Syndrome), left the mother, Gail Schwartzman of Hicksville, N.Y., with a cluster of symptoms including a 35 dB sensorineural hearing loss in the middle frequencies.
In 2006 Schwartzman's child, then 4, kissed her mother on the left ear. Hearing loss and pain led Schwartzman to consult with a number of doctors before Reiter finally discovered the cause of her symptoms in 2007.
"It was a real smacker," Reiter said. "[Schwartzman] described it as the air being drained from her head. She had intense pain and at first lost total hearing in her ear." Other symptoms included screeching tinnitus and unprovoked spontaneous spasms of her facial muscles.
Some hearing returned after several days, but Schwartzman continued to experience tinnitus, occasional facial twitching, and hyperacusis. She also had the feeling when turning her head side to side that something was moving within her ear. Reiter suspected that the ossicular chain within the ear had been damaged by suction from the kiss.
Prior to visiting Reiter, the patient had undergone a number of tests that failed to disclose the cause of her difficulties. Reiter noted that although doctors tested her acoustic reflexes, they did so only ipsilaterally. Reiter believed that a complete battery, consisting of ipsilateral and contralateral acoustic reflexes, would reveal more information. He obtained an acoustic reflex pattern that typically represents a seventh cranial nerve lesion, he said.
"It indicated that the motor side of the reflex in the affected ear was the only thing that was not functional; the stimulus side was okay," he said. "But in the impaired ear, I got no reflex. Something was paralyzing that acoustic reflex. It seemed to me logically that an ear kiss is not going to affect the seventh cranial nerve."
Ultimately, Reiter found that the stapedial musculature had been damaged, paralyzing the ossicular chain. To support his theory, he sent the patient to an otolaryngologist for facial nerve testing. The facial nerve was found to be fully functional.
"When the child sucked on the ear canal, the ear drum came toward her lips, pulling the ossicular chain laterally," Reiter explained.
"This damaged the stapedial musculature but also pulled the stapes away from the oval window, probably causing a miniature ‘tsunami' in the inner ear fluids, damaging cochlear hair cells."
Rap and Audiology
Once Reiter confirmed the diagnosis and had a publication date for his journal article, he became a media hit, with appearances on national network television morning shows and a feature article in Newsday. In fact, Newsday is how Schwartzman first learned of Reiter's work—she contacted him after reading an earlier article describing Reiter's involvement with music in the audiology classroom.
"She had been suffering. Physicians tried giving her hormones and steroids and nothing helped," he said.
Since Reiter's detective work in the ear-kiss case has been reported, he has received many phone calls and e-mails about similar cases. Mark Ross, professor emeritus at the University of Connecticut, told Reiter of a similar case that Ross and Fred Martin encountered about 50 years ago, although the findings were never published. Reiter is now involved in an epidemiological study of the phenomenon.
Schwartzman continues with a 35 dB sensorineural hearing loss and tinnitus, and her discrimination in both ears is good. The facial twitching has disappeared but returns for a few days after she has been at a noisy event.
"That's basically where she is holding currently," Reiter said. "We have to use moderation in kissing on the ear. Keep your iPods [turned] down and your lips away from the ear."
Levi Reiter is seeking information about similar hearing loss cases. He can be reached at firstname.lastname@example.org.