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Presenting Symptoms of Havana Diplomats Defined

by Amy E. Hamaker •

What are the clinical presenting symptoms of diplomatic personnel residing in Havana during the acute time period in autumn 2016?

Bottom Line:
Immediately after exposure, the majority of affected individuals reported intense ear pain in one or both ears and experienced tinnitus. All of the individuals noticed unsteadiness and features of cognitive impairment, and formal testing revealed that all individuals had an otolithic abnormality and evidence of cognitive dysfunction.

Background: Beginning in late 2016 and continuing into 2017, a number of diplomats and family members stationed in Havana, Cuba, began to report sudden onset dizziness, ear pain, and tinnitus. Most of those affected reported hearing an unexplained noise before the symptoms began that was loud, high frequency, very localized, and capable of following them throughout a room. Several reported that if they went outside their front door, the noise immediately stopped, while others reported a sensation of pressure passing through their head and abdomen in certain parts of the room that could be relieved by moving a few feet away.

Study design: Review of 25 symptomatic individuals who reported a localized sensation of noise/pressure and 10 asymptomatic individuals who did not experience the sound/pressure.

Setting: Departments of Otolaryngology, Neurological Surgery, and Neurology, University of Miami Miller School of Medicine, Fla.

Synopsis: Individuals (21 males and 14 females) under age 64 were examined approximately four to 60 days after the most recent exposure. Affected individuals all reported direct exposure to either noise or pressure. Immediately after exposure the majority of affected individuals felt intense ear pain in one or both ears and experienced noticeable tinnitus; all noticed unsteadiness and cognitive symptoms (disorientation, lack of mental clarity, slower processing speed, difficulty sustaining attention) within 18 hours. Dizziness and cognitive complaints were the most common individual symptoms in the affected group. All individuals had a normal ear exam with the exception of focal erythema in the symptomatic ears of the seven individuals complaining of ear pain. All individuals with dizziness/balance disorders had abnormalities on the qualitative vestibular clinical examination either on spontaneous gaze or on rapid head thrust test for more than one passive head motion frequency. There was a high abnormality rate in the subjective visual vertical test. The combination of subjective visual vertical (SVV) abnormalities and the high prevalence of deficits in both cervical and ocular vestibular evoked myogenic potential (VEMP) metrics was suggestive of an asymmetric peripheral vestibular pathology affecting the otolithic organs. Despite almost one third of individuals reporting hearing loss, only two individuals had abnormal hearing tests. Formal neuropsychological testing confirmed complaints of “cognitive fog,” problems retrieving information on demand, and increased irritability and anxiety in those with specific cognitive complaints. Limitations included the retrospective data analysis, limited sample size, and limited patient examinations.

Citation: Hoffer ME, Levin BE, Snapp H, Buskirk J, Balaban C. Acute findings in an acquired neurosensory dysfunction. Laryngoscope Inv Otol. Published online December 12, 2018. doi: 10.1002/lio2.231.