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Lita Hoile hurried toward the Psychiatric Ward of Munson Hospital as her pager went off for the second time. The colors of mangled innocence were the hardest to endure… for both the victim and the healer. He came lumbering down the corridor: a hulk of a man reeking of old sweat and malt whiskey, features little more than a shadow in Lita's mind. It happened so fast: Bill chugging past her in a blur, launching himself at a silhouette of fire.
The orderlies pulled Sarah's father to his feet and dragged him down the hall, security guard trailing warily behind them. Lita had known about the eclipse for weeks - vaguely, through half-heard conversations and snippets on the Evening News. She gave up after a couple of hours and plopped down in front of the TV, ready to soak her brain in something tepid and mindless.
Lita lay awake in bed for a very long time, unable to escape the glow of her own ripening terror. She remembered seeing it on the screen at the beginning of the interview - something foreign, Slavic perhaps. Allendale Lane lay nestled in a middle-class neighborhood less than a mile from the hospital.
Lita walked around the side - past a row of scraggly hedges - saw a crowd gathered in the tiny back yard: men and women, boys and girls huddled together on a carpet of dead leaves. She had her answer, as he stretched out ebony fingers to grasp her hand: Sceadu was no prophet of the Darkness.
The old priest hunched in the doorway - more ancient than she remembered - hands quivering with palsy.
Someone grabbed Lita's arm and yanked her into the room, pushing the door closed behind her.
Papa Baxter flashed scarlet as the flames tried to burn through enshrouding darkness, but his Light shrank back to a line of burning blood.
Lita spent the rest of the morning working with Sarah, trying to heal the bruises Papa Baxter left behind… feeling her own spirit dim as she watched the little girl sink deeper into the jaws of the eclipse. She stared at him - not his dying Light, but him - tousled hair and steel gray eyes, hawk nose and quirky grin. Fury kindled deep inside, burning through the fear, rising from that dark abyss into which she felt herself slipping… felt them all slipping.
A new Light bloomed on the horizon: brighter, more glorious than any human mind could fathom. Light beckoned in the distance: a special kind of radiance, requiring a special kind of vision. MIXED HEARING LOSS Whenever the hearing loss of a patient includes a mixture of both conductive and sensorineural characteristics, is said to have a mixed hearing loss.
Superior ventral cochlear nucleus (SVCN) Erythroblastosis typically causes hearing loss that centers around 3000–4000 Hz.
Central Auditory Processing Disorders (CAPD) CAPD characterized by decreased understanding of speech in the presence of background noise. FUNCTIONAL HEARING LOSS Functional or psychogenic hearing loss is the customary diagnosis when there is no organic basis for the patients apparent deafness.
Functional Overlay It is entirely possible for hearing loss of functional origin to be superimposed on true organic hearing impairment.
History: A 34-year-old woman with otosclerosis and hearing loss for over 10 years Refuse to use hearing aids She often says, What?
Audiometric Patterns in Functional Hearing Loss There is no characteristic audiometric pattern in functional hearing loss, but the consistent inconsistencies serve to alert the physician.
Malingering Malingering is the deliberate fabrication of symptoms that the patient knows do not exist. For some time I have been hearing my heart beats in my ears It is variously described as a heartbeat sound in your ear, the sound of someone.
The sound of heartbeat in the ear may be caused by the swelling of the artery Why can I Hear my Heartbeat in my Ear? What would cause a muffled thumping sound in my left ear (almost like hearing a heart beat)?
Jul 7, 2009 The noise, an incessant loud whooshing in his left ear, was driving Roger Luchs crazy -- literally by a ringing sound, less often by the pulsating noise Luchs heard. If you hear a pulse-like noise in your ears, it may be pulsatile tinnitus people complain of a whooshing or thumping sound, often in sync with one's heartbeat. I also have a pulsating (heartbeat) sound in my right ear and have It feels exactly like you are wearing. Tinnitus that has a pulsing sound (like hearing your heartbeat in your ear) What Causes Tinnitus?
Pulsatile tinnitus may sound like a whooshing, swooshing, screeching, creaking, It was in time with my heartbeat and sounded to me like a Doppler of a baby in utero. Feb 12, 2010 Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood  Q: I sometimes hear ringing in my ears, is this unusual?
She spotted Bill Meltzer outside one of the examining rooms, face unusually grim, straw-blond hair mussed where he always ran his fingers through it when a tough case had him stumped. The brassy gleam of self-confidence suffused him, surrounding a sickly yellow core of doubt. A little girl crouched in one corner in a faded jumpsuit covered with leering images of Minnie Mouse.
Sarah rose on spindly legs, held out the hand that did not have its thumb jammed in her mouth. Lita steered her down the corridor toward the Cafeteria, scanning for the first glimmer of trouble. She grabbed a Diet Coke and a bag of stale pretzels, went straight to her Mac, and dove into the Net, surfing for anything she could find on the eclipse.
A nightmare chased her out of fitful slumber well after midnight, snapped her eyes open as she struggled to untangle sheets grown clammy with her sweat.
Lita passed them on the way to work: a parade of zombies with blank, black crescents slicing through their Inner Light.
A wedge of darkness curved along her side, leering at Lita like the sideways grin of some toothless demon.
That self-proclaimed prophet from the Evening News, he saw it too: the knowledge had been there, hidden in his spooky eyes. She walked it, to give herself time to think about what she would say… about how crazy she would sound if this man's particular vision did not coincide with her own.
She stumbled past Sceadu's startled neighbors, past their barking dogs and squealing children.
He peered at her from behind glasses ridiculously thick, making his eyes look like a pair of watery amoebas trapped beneath the lens of a microscope. Lita spent most of it wrestling with blankets that offered no warmth at all, sobbing into the darkness… watching it eat away at her. Doctors, nurses, orderlies, patients all moved in a languid fog, as if the darkness had filled their limbs with sludge. A week ago he would have argued and cajoled, refused to give her peace until she surrendered. Lita swung her eyes toward the bed, saw the tiny figure buried in a nest of pillows: wide brown eyes staring blankly past both of them, little mouth sucking fiercely on a thumb. She worked through lunch, devoid of appetite, focused her remaining strength on breaking through Sarah's shell of silence while counting the hours - the minutes - until totality.
Just before three, Bill Meltzer popped his head inside the door and tried to smile, his Light a mere flicker of blue and yellow. At least forty of the Hospital staff sat, stood, or lay up there already, with a few of the ambulatory patients sprinkled among them.
You taste so very sweet, as I knew you would, but perhaps I'll start with the choicest morsel first. She dragged the child after her, stumbled toward that lone, unblinking star, knowing there would be no other chance. It streamed from her in all directions, crackling through the void, sheathing other souls in incandescent armor.


It swelled across the sky, boiling away shadows, chasing Darkness back into Its lesser Kingdom. Hearing deficiency may have started originally as a conductive failure (otosclerosis) and later developed a superimposed sensorineural component. In clinical practice, most cases with an original sensorineural etiology remain in that classification without an added conductive element.
In chronic otitis media some toxic inflammatory metabolite produces a cochleitis or labyrinthitis.
This example a warning to physicians to avoid assuring any patient that his hearing loss can be corrected merely by removing cerumen, because mixed hearing loss may be found subsequently. In every case of mixed hearing loss one should determine how much of the deficit is conductive and how much is sensorineural. If the patient does not understand any better with a hearing aid or when the voice is raised, hearing is not improved even if the conductive portion of the mixed hearing loss is corrected. 17 The auditory pathway consists of a series of transducers that repeatedly change the speech stimulus so that it can be handled effectively by the cortex. Characteristic Features of central hearing loss : Hearing tests do not indicate peripheral hearing impairment. This may be caused by injury to SVCN spheroid cells, the second-order neurons of the ascending auditory pathway, even in the presence of normal hair cells in the organ of Corti. Common complaints include inability to study or read in the presence of noise, slowing of reading speed caused by noise(vacuum cleaners or air conditioners ) and suspicion by family members that the patient has a hearing loss. The inability to hear results entirely or mainly from psychological or emotional factors, and the peripheral hearing mechanism may be essentially normal.
Psychogenically induced hearing loss usually is a uniform flat- tone loss in all frequencies, suggestive of a well-marked conductive impairment. Usually, the hearing impairment is bilateral, and the bone conduction level is the same as the air conduction level.
I guess what I’m wondering is what you think it could be and whether or not it would be worth seeing an ENT about? The most common reason is simply that you have some fluid between your ear drum and a blood vessel in your skull. DEAR DOCTOR K: I can hear my heartbeat in my left ear We agreed that what you describe sounds like. Brown hair drooped across her face in greasy tangles, wide brown eyes oblivious to the presence of another stranger. A commotion erupted in the Admitting Area ahead, a gruff voice shouting obscenities; the little girl froze, squeezed Lita's hand so tight the knuckles ground together. Flames of orange and vermilion blazed inside him; she could feel the heat of his psychic fever spraying sparks of poison. The Light of Sarah Baxter's father spat red and orange virulence in every direction… except one. Their Inner Lights glowed in tainted harmony, and a shadow carved out sections of their souls. When they prattle on about nuclear Armageddon, they ascribe far too much power to the puny human species. Her aura glimmered above the covers: bright magenta now, with fresh streaks of violet, so much like that little girl's.
She decided to visit Sarah Baxter in the Children's Ward right after her morning infusion of coffee, hopeful that they could make some progress. Lita tried to comfort the little girl, to paint the colors of her suffering with softer shades, but she could not heal that darker wound.
She went to her office, grabbed a dog-eared phone book from beneath a stack of case files that looked like a badly shuffled deck of cards, fingers trembling as she turned the pages. The fresh air cleared her head: a crisp autumn day, not too cool, wind spiced with the aroma of burning leaves.
She could see the mad tangle of Lights in the circle of Sceadu's congregation, each one defiled by its own vertical grin of darkness.
Anne's and wondered if the priest she remembered from Sundays long past would still be there, face as cracked and faded as the church itself.
His Inner Light glowed blue, a welcome shimmer of compassion… except that half of him was gone. Panic danced in his eyes, a spark of violet in his aura: maybe for the first time, the man was scared.
For an instant, Lita stared into the depths of a shadow ripped from the body that had cast it. Somebody had smuggled a stash of leftover doughnuts from the Cafeteria and spread them out on a bedsheet like a hobo's buffet.
She could no longer recognize any of the auras, spectral lines tracing perimeters of shadow. Lita could barely feel Sarah's little hand clenched in her own; all sense of physical contact was fading like the Sun. A nightmare landscape now stretched toward infinity - barren, rocky plains of obsidian and coal, frozen crust of black layered upon black. She collapsed, tumbled into darkness, stretching out her fingertips to touch that fleeting star.
She could see it - oh yes, she could see it - flaring and flickering around her, wrapping her in a halo of radiance. He sank his fangs into the child's tender spirit, ravaging without mercy, ripping open wounds that had never been allowed to heal. Coronas of white and blue and gold blazed into view, scattering across the rooftop like a galaxy of newborn stars.
Phantoms drifted aimlessly through the gloom like wayward comets deflected by the whims of gravity. The difficulty may have been sensorineural in the beginning ( presbycusis ), and a conductive defect (middle-ear infection ) may have developed subsequently.
In contrast, most cases that start as conductive hearing impairment later develop some sensorineural involvement. The sensorineural deficit may be caused by penetration of the oval window with exposure of the perilymph.
Prognosis: In mixed hearing loss the prognosis depends on the relative proportion of conductive and sensorineural pathology. There is no characteristic audiometric pattern, except that the disparity between the hearing level and the speech interpretation is quite marked. Central pathology must be included in the differential diagnosis of the hearing loss producing a 4000-cycle dip on the audiogram. If people talk to a person with CAPD while he or she is involved in auditory concentration such as listening to a television program, the person will often not hear. The basis for functional hearing loss in most patients is psychogenic, the product of emotional conflict, ( neurotic anxiety ).
Hysterical blindness and paralysis are other examples of the same type of somatization or conversion reaction. In a patient with unilateral functional deafness there may be complete absence of bone conduction on the side of the bad ear, though the good ear has normal acuity. If the patient claims he has one good and one bad ear, and the examiner obstructs his good ear with a finger, then shouts into it loudly enough to be heard easily by bone conduction alone, the malingerer claims he hears nothing. First, I just want to say that I’m a relatively new follower, but I absolutely love your blog!
At first it was more of a swishing sound and I thought it was fluid in my ear until it became clearer and I could hear it was actually my heartbeat.
And something she rarely saw in Bill - bubbles of lavender floating through the rest, flashes of pastel fireworks. A line of darkness nibbled at the edge of him, curved across the molten surface of his soul like the shadow of some invisible moon. A chuckle turned into a groan: Channel Eleven was running a fluff piece on myths surrounding the eclipse. Lita felt like a trespasser at the scene of some pagan ritual - she could smell the tang of a nearby barbecue, hear the sizzle of roasting meat. She leaned against a mailbox on Fifth Street, gasping for air, ignoring the stares of passersby who could not see their own souls slipping into oblivion.


Bill always shot her a smile in the mornings - something between a smirk and a leer, usually accompanied by some crack about waking up his libido. She looked down at the little girl clinging to her - saw darkness spreading through the child's tormented Light like a tumor - and knew her tears could not wash away the stain. She watched in awe as the black disc edged further into the last vestige of the Sun; the sliver of yellow fire seemed to brighten, fighting in desperation to repulse the final charge of shadow armies.
Sceadu's roar battered her from every side - she could feel him closing in, breath hissing against her neck like blasts of arctic wind. Light, shimmering and liquid, flowing into every chamber of her soul, covering her like another layer of skin.
In some cases the conductive and the sensorineural elements may have started simultaneously ( severe head injury affecting both the inner ear and the middle ear ). Despite meticulous surgical care, the inner ear also can be traumatized readily and made more susceptible to infection. The best way to approximate the conductive and the sensorineural components of a hearing loss is to perform all possible tests for estimating the patients sensorineural potential or cochlear reserve. If the sensorineural component is slight, the surgical prognosis is good, and under favorable circumstances the hearing may approximate the level of the bone conduction.
In certain cases, central hearing loss may mimic peripheral causes of deafness, including occupational deafness.
However, if one gets the persons attention by calling his or her name before speaking, the first sentence will not be missed, and hearing is normal.
Tinnitus is a characteristic feature of hysterical deafness, and patients often claim that the noise is unbearable.
Too spectacular an improvement with a hearing aid, especially when the patient has set the controls at minimal amplification, or a sudden disproportionate improvement in hearing after a simple procedure such as drum massage or insufflating the eustachian tube. Such a patient even may deny hearing shouts directed at the bad ear in spite of the good hearing in the opposite ear. It started when my ear was infected, but I got medication for it and I thought it would go away. I assumed that it was something to do with my veins or arteries because when I press on my neck I’m clearly blocking the blood flow. The only total eclipse that will hit Munson in our lifetimes; the umbra will pass over us almost dead center.
Not too little information, but too much: Celtic dragons swallowing the Sun, Mayan gods demanding bloody sacrifice, Chinese emperors cowering from celestial omens of their own demise. Lita sank into the crumb-filled cushions of her couch and listened to the reporter interview some crackpot who claimed to have the gift of prophecy. For centuries, shamans from your local Pottawatomi tribes have predicted that a day would come when Gitchi Manitou would place His hand over the Sun and send the wendigoes into a Night That Is Not Night to eat the souls of the unworthy. Part of her had vanished in a smooth, black arc, as if the night had loosed invisible piranha to gobble her essence with geometric precision.
Friends she had known for years at the Hospital seemed remote, disoriented, floating through the halls like the ghosts of the recently departed.
Is this how the cancer patients feel, watching the tumor grow larger on every x-ray, knowing there's no way to stop it? She dialed Directory Assistance, already feeling the sinking sensation in her gut, the certainty that he would not be listed. She rang the doorbell half a dozen times, heard the harsh electric buzz reverberating inside the house. She could not see him, but she felt him even before he spoke, his words as chill and merciless as winter wind. She lay in bed well past the piercing reveille of her alarm, wondering if there was any point to going in. Lita shuddered with relief… and anger, rising in a molten tide, overflowing the black barriers that squeezed her soul like a vise.
Bill had several extra pairs of glasses distributed by the Munson Science Club for viewing the eclipse; he gave her and Sarah each a pair. The Lights of those around her joined in the battle, losing ground to an enemy they could not even see.
She saw something at the edges of her vision: a microscopic spark, a single pinprick in Sceadu's suffocating shroud. Still she chased the star, pulling Sarah with her; she could see it pulsing in the darkness, heartbeat of a lost and distant world. In surgical trauma to the inner ear, high-frequency hearing loss often falls below the preoperative level, and the patient may complain of reduced discrimination though his pure-tone threshold is improved. However, the discrimination is not improved much, even after correction of the conductive defect. The chief function of the auditory cortex is to interpret and to integrate these impulses and to provide the listener with the exact meaningful information intended by the speaker, or to permit the listener to react appropriately to the actual implication of the sound.
The spheroid cells of the superior ventral cochlear nucleus (SVCN) show an anatomical frequency gradient, low ventral to high dorsal. Treatment : altering the listening environment to obtain the best possible signal-to-noise ratio. Hearing acuity usually varies, depending on the patients emotional state at the time of testing. In complete deafness the presence of cochlear nerve reflexes with loud noises indicates either malingering or hysteria.
Lita grabbed the little girl and held her tight as the Light of terror screamed silently around them. A disheveled Bill Meltzer crawled off the man's chest - huffing and puffing, angrier than she had ever seen him - and tried to straighten his unruly mop of hair. Even Bill Meltzer - hyperactive Billy Boy - barely said good-morning to her in the Cafeteria, his smile as bland and lukewarm as the eggs.
Sarah's father glared back at her, chest heaving like a man in the throes of a coronary, meaty paw brandishing a very nasty knife. If the patient hears and discriminates well when speech is made louder, then the conductive element probably is a major cause of the hearing difficulty, and there is a good chance that surgery will improve the hearing. A similar adverse effect is noted in the ear opposite the tumor when certain words are interrupted periodically or accelerated.
He glared at the security guard, who pointed his pistol between the orderlies, trying to look like he had the situation under control. Lita wandered familiar corridors made strange by the unnatural way light mixed with shadow, chased by the echoes of her own footsteps. Then the wall of bodies parted and Sceadu strode toward her, a smile splitting his dark features. She stumbled around the corner, not quite able to catch her breath, not quite sure where else to go. Anne's scowled down through the gloom as she climbed the stone steps to the massive oaken doors, pushed. The last precious breath of light died in a blackness more dense and inescapable than anything Lita had ever known.
Joy warmed her like the kiss of Summer, filled her with so much Light she felt that she might burst. Labyrinthitis Otosclerosis was at one time thought to retain its purely conductive character for years; today it is recognized that this condition develops sensorineural impairment in same cases. Anne's in years - not since she was a fidgety child ruffling the pages of her hymnal - but she needed help. Papa Baxter still burned, but no longer a feverish inferno - more like a campfire sputtering as the last log splinters into embers.
As she stared into that lonely star - Sceadu's laughter ringing in her ears - she realized something else: Sceadu could not see it.



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