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University of Miami Medical Team Reports Acute Findings

from the Havana Embassy Phenomenon

A team of University of Miami Miller this dysfunction is important for better
School of Medicine faculty, along with col- defining the disorder and for developing
laborators from the University of effective diagnostic, preventive, and
Pittsburgh, recently presented the first treatment strategies,” said Dr. Levin. “We
report of acute symptoms and clinical believe our findings provide a better pic-
findings in 25 diplomatic personnel living ture of the initial injury pattern after this
in the U.S. Embassy in Havana, Cuba, who exposure and may allow for more accu-
experienced severe neurosensory symp- rate diagnosis in future cases.”
toms after exposure to a unique sound and The collaborative study shows the
pressure phenomenon. power of a large interdisciplinary team
“Objective testing showed evidence of a that spans specialties and universities,”
balance disorder that affects the inner ear said Dr. Balaban, who has studied the cir-
and a unique pattern of cognitive and cuits to the brain relating to balance dis-
behavioral dysfunction,” said Michael E. orders, anxiety and migraines in patients
Hoffer, M.D., professor of otolaryngology at the University of Pittsburgh. “A holis-
and neurological surgery. “This cluster of tic integrative approach is vital for under-
auditory and neurological symptoms, standing the scientific basis of this com-
along with associated psychological issues, plex disorder.”
does not resemble more classic traumatic “This is a perfect example of how aca- Evaluating the cases Considering the cause
brain injury (TBI) based on our team’s vast demic medicine brings together expertise Over the next few months, the Miller While the Miller School study did not
experience in this area.” and collaboration in the name of discov- School team conducted evaluations of all attempt to determine the cause of the
Dr. Hoffer was lead author of the study, ery and science,” said Henri R. Ford, individuals who suspected they were symptoms in these U.S. Embassy resi-
“Acute Findings in an Acquired M.D., dean and chief academic officer of affected between 4 and 60 days after expo- dents, the authors noted that intense ultra-
Neurosensory Dysfunction,” published in the Miller School of Medicine. sure, as well as a larger group of 105 sonic radiation can produce “a syndrome
the peer-reviewed journal Laryngoscope embassy workers who denied any “expo- involving manifestations of nausea,
Investigative Otolaryngology. The Miller The onset of symptoms sure” to noise or a pressure sensation. headache, tinnitus, pain, dizziness, and
School study included a review of 25 indi- Beginning in late 2016 and continuing The evaluations were carefully coordi- fatigue,” based on occupational health liter-
viduals at the U.S. Embassy who reported into 2017, a number of U.S. diplomats nated and conducted by multidisciplinary ature. “The exposure responsible for these
a localized sensation of noise/pressure and and family members stationed in medical teams from otolaryngology and findings is unknown,” said the co-authors.
10 individuals who were roommates of Havana, Cuba began to report com- neurology. “Our broadly scoped team of 15 “It would be imprudent to exclude any
those affected and did not experience the plaints of sudden-onset dizziness, ear audiology and neurotology specialists potential directed or non-directed energy
phenomenon. pain, and tinnitus. Most of the affected draws on our advanced vestibular testing sources at this time.”
“This is the first and only report of the individuals reported hearing an unex- technology for diagnosis and treatment In their study, the authors recognized
acute presentation (seen shortly after plained noise before the symptoms and management, thanks to the Miller Kurt Yankaskas, program manager at the
exposure) in this unique group of began. They noted the sound was loud, School’s longstanding investment in our Office of Naval Research, for comments
patients,” said Dr. Hoffer. “Our findings localized, at a high frequency and could clinical program,” said Dr. Snapp. helping to clarify the work; Alexander
are not biased or influenced by the effects follow them throughout a room. Several All of the 25 individuals with symptoms Kiderman, Ph.D., chief technology officer
of time, variable amounts of rehabilitation, individuals reported that if they went noticed unsteadiness and features of cog- at NKI, for designing the software and
workers compensation concerns, or media outside their front door, the noise imme- nitive impairment, according to the study. hardware used to analyze these patients;
attention. It is an important contribution diately stopped. Others reported a sensa- Dizziness (92 percent) and cognitive com- Constanza Pelusso, M.D., research director
to this field, and these data will provide tion of pressure passing through their plaints (56 percent) were the most com- in the Department of Otolaryngology, for
further insights into determining what head and abdomen in certain parts of the mon symptoms. Formal testing revealed her help in filing all necessary patient
happened.” room that could be relieved by moving a that 100 percent of individuals had an research forms and reports; and Danierys
Carey D. Balaban, Ph.D., professor of few feet away. otolithic (balance) abnormality and evi- Font for her assistance in scheduling all of
otolaryngology, University of Pittsburgh In February 2017, Dr. Hoffer, a former dence of cognitive dysfunction, as docu- the patients. They also thanked Fred
School of Medicine, was co-author of the military officer with security clearance, mented by a battery of standardized meas- Telischi, M.D., chair of the Department of
study, along with the Miller School’s was contacted by the U.S. State ures. Otolaryngology, Anthony Etzel, M.D., vice
Hillary Snapp, Au.D, Ph.D., associate Department about an individual who After the evaluations, a number of the chair of administration in the Department
professor of otolaryngology and chief of reported hearing an odd noise followed by patients were treated for balance, cognitive of Otolaryngology, and Ralph Sacco, M.D.,
Audiology; Bonnie E. Levin, Ph.D., pro- intense ear pain and tinnitus. By the next and emotional disorders. “We reviewed MS, professor and chair of the Department
fessor of neurology and director of the morning, the individual was dizzy and had options for therapeutic interventions to of Neurology, as well as the audiologists,
Division of Neuropsychology; and James mild cognitive issues, such as processing address their physical, mental and emo- nurses and staff of the Department of
Buskirk, PT, SCS, a doctoral student. emails slowly and forgetfulness. tional issues,” said Dr. Levin. Otolaryngology for their assistance in car-
“Understanding the acute symptoms of
ing for these individuals.

2019 SFHHA Board of Directors in Attendance

at the December 2018 Annual Meeting & Dinner

South Florida Hospital News southfloridahospitalnews.com January 2019 9