Hypercalcaemia and abdominal pain.

serum immunoglobulins and IgG led us to suspect the auto-immune nature of the problem. The immune-mediated hearing loss can present as a solitary event or as a part of a more generalised auto-immune disorder. It is usually bilateral and symmetrical; vertigo and tinnitus may or may not be present. Since there is no characteristic presentation, such a diagnosis should be considered in a patient presenting with any combination of these symptoms. Certain clinical features should raise the alarm (box).7 Steroids and immunosuppressant therapy are the mainstay of treatment. We used azathioprine and obtained a good response. Fluctuations in hearing thresholds were observed during the initial adjustment of the steroid dose. Subsequently, the hearing remained improved to a useful level, despite gradual tapering of the steroids (figure 2). In conclusion, immune-mediated hearing loss is one of the few forms of sensorineural deafness that are treatable by medical means.9 The diagnosis can sometimes be difficult due to a wide variation Features suggestive of immune-mediated hearing loss