E4


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TUESDAY, JULY 27, 2010 For this ear ailment, waiting can be very risky mystery continued from E1


ness, he told Locke, and the hear- ing in his right ear seemed nor- mal. Locke peered into Curtis’s ear and tested his hearing using a tuning fork. The tests revealed that Curtis was virtually deaf in his left ear and that the problem appeared to be located in the in- ner ear. At that point, Locke recounted, he was fairly certain what was wrong: Curtis was suffering from idiopathic sudden sensorineural hearing loss — sudden deafness in one ear, which affects between five and 20 people per 100,000 annually. Unlike conductive hearing loss, which affects the outer ear, sud- den sensorineural hearing loss is an urgent medical problem that can range in severity from mild to profound. Curtis’s was so severe it could have left him permanently and totally deaf in one ear. In most cases, including Curtis’s, the cause is unknown; treatment with corticosteroids has demon- strated success in some patients. Curtis was stunned, particular-


ly after Locke described the first case he had seen, which left an in- delible impression. Soon after finishing his resi-


dency in 1996, Locke saw a pa- tient who told him that 20 years earlier she had woken up unable to hear anything in one ear; her hearing never returned and Locke does not know if she sought treatment. Locke treated her for a seemingly minor problem in her good ear; two days later she was back in his office, unable to hear out of that ear and now complete- ly deaf.


“Obviously this was quite dra-


matic, and we were able to get her an immediate appointment with an ear, nose and throat specialist,” Locke said, adding that treatment restored hearing in the second ear. The ENT later told Locke that some patients suffer permanent deafness as a result of delays in di- agnosis and treatment of sudden sensorineural hearing loss. Often they or their physicians mistak-


Proof that treatment works re- mains ambiguous. A 2006 Coch- rane Review, updated last year, found that one small study dem- onstrated that prompt treatment with steroids was linked to a sig- nificant improvement in hearing — 61 percent of patients com- pared with 32 percent who took a placebo — while another study failed to demonstrate a benefit. Both studies, researchers said, contained too few patients upon which to draw a firm conclusion. Even so, most doctors prescribe prednisone for the problem be- cause the potential benefits out- weigh the risks of the drug. Locke’s office arranged for Cur- tis to be seen immediately by an ENT at Johns Hopkins Medicine. After further testing, Curtis agreed to enroll in a multi-center study, funded by the National In- stitutes of Health and led by Rauch, comparing several weeks of oral steroids with medication injected directly into the ear. Called intratympanic treatments, this method delivers a high con- centration of drug to the affected area, avoiding the systemic effects of steroids, which can include mood changes, insomnia and weight gain. Results of the study are pending. Curtis called the injections


EVY MAGES FOR THE WASHINGTON POST Wayne Curtis recovered his hearing within weeks, although he said that the injections he opted to receive were extremely painful.


enly attribute the problem to al- lergies or respiratory congestion from a cold. For reasons that are unclear, the window for effective treat- ment appears to be two to four weeks from the time a patient is aware of diminished hearing; af- ter that, hearing loss can become permanent, writes Harvard pro- fessor of otolaryngology Steven D. Rauch in a 2008 article in the New England Journal of Medi- cine. Rauch reports that the mala- dy affects men and women equal- ly and typically occurs between


“I had always assumed that something as serious as losing your hearing would be accompanied by pain like an earache or damage.


This was just so out of the blue.” Wayne Curtis, who thought allergies were causing his hearing loss


the ages of 43 and 53. Some patients, he writes, never seek treatment and recover spon- taneously, usually within 14 days. Prognosis depends on the severity of the problem: Patients with mild hearing loss are most likely to make a full recovery without treatment, while those with pro- found hearing loss, such as Curtis, rarely show spontaneous im- provement. Even with treatment, which typically involves a few weeks of oral corticosteroids such as prednisone, some patients nev- er recover their hearing.


“one of the most painful treat- ments I’ve ever had to endure. It felt like acid eating into my ear.” But within weeks, his hearing was fully restored. He says he feels lucky that he called his doctor in time and grateful that Locke recognized the medical emergency and en- sured that he received rapid treat- ment.


“I had always assumed that


something as serious as losing your hearing would be accompa- nied by pain like an earache or damage,” Curtis said. “This was just so out of the blue.”


If you have a Medical Mystery that has been solved, e-mail medicalmysteries@washpost.com. To read previous mysteries, go to www.washingtonpost.com/health.


Will Strasburg be the fastest? Maybe.


strasburg continued from E1 Strasburg’s complex series of


perfect motions starts when he raises his left foot. The energy moves from the legs to the pelvis, to the trunk to the shoulder to the elbow, to the wrist to the finger- tips — and, finally, to home plate. Scientists call this the kinetic chain, or the process of trans- ferring energy from one link in the body to the next. Coaches call it coordination. “His mechanics are sound and


very fluid,” Nationals General Manager Mike Rizzo says. “The ef- fort he exerts to get to maximum velocity is very minimal for his miles per hour. . . . The effortless delivery translates into more command over the pitch.” In oth- er words, Strasburg makes throw- ing a ball 100 mph look easy.


No weak links Glenn S. Fleisig, the research


“The lower body . . . is where the power comes from,” says Nationals General Manager Mike Rizzo. “When I saw Stephen, he looked like a big, physical horse of a pitcher.”


JONATHAN NEWTON/ THE WASHINGTON POST


director at the American Sports Medicine Institute in Birming- ham, Ala., has analyzed the me- chanics of about 2,000 baseball pitchers since 1987. (ASMI was founded by orthopedic surgeon James Andrews to understand and prevent injuries in sports. “The mission was to put himself out of business,” Fleisig says.) Major league coaches send pitchers to the ASMI laboratory, which has a regulation-size space to throw the ball: 60 feet, 6 inch- es, from rubber to plate. (Little League, high school and college players also go to ASMI for evalu- ation.) Fleisig sticks about 25 sen- sors on the pitcher and points eight cameras on him while he throws the ball. It’s the same technology used for creating spe- cial effects in movies and video games. The sensors and cameras con-


nect to a computer, which spits out a 15-page document called a “biomechanical analysis of pitch- ing delivery.” How fast does the pelvis rotate, in degrees per sec- ond? What’s the angle of the lead knee when the foot hits the ground? Is the trunk tilted for- ward at the moment of ball re- lease, as it should be? (The ideal tilt, for example, is in the range of 37 to 44 degrees.) “What makes a good pitcher is


not that he bends his elbow or knee the right way,” says Fleisig, who has not analyzed Strasburg in the laboratory. “What makes him good is that he doesn’t have a weak link in his chain of events or


fore he releases the ball.) The shoulder of an elite pitcher moves faster than any body part of any athlete in any sport, Fleisig says.


Other 100 mph pitchers include Joel Zumaya, left, and Nolan Ryan.


a mistimed motion.” (We were not able to ask Stras- burg any questions. Exact words from a Nationals spokesman: “Welcome to the clubhouse. You can interview anyone not named Stephen Strasburg.”) Aspects of Strasburg’s anato-


my, including his height, hands, legs and the soft tissue in his shoulder, help him throw the ball faster, but there is no paper-doll ideal for what a great pitcher looks like. The 6-foot-10 Randy Johnson, who retired this year, didn’t have a big lower half to power his windup, and the As- tros’ Roy Oswalt, who is listed at 6 feet tall, doesn’t have height. Strasburg is a big guy: 6-4 and 220 pounds. Rizzo, who worked as scouting director for the Ari- zona Diamondbacks before he joined the Nationals in 2006, says that Strasburg passes his “eye test” for a pitcher. “You want a big, physical guy,” Rizzo says. “It’s a very physically demanding position, and the low- er portion of the pitcher’s body is vitally important. The lower body — the legs, the core, the hips and the butt — is where the power comes from and where the strength comes from. When I saw Stephen, he looked like a big, physical horse of a pitcher.” Nationals relief pitcher Drew Storen, who is 6-2, says Stras- burg’s pitches have a great down- hill plane. “The ball is so far up, and it has


to go down to the catcher, and that’s pretty hard to hit,” Storen says. “I don’t have that luxury.” Storen also mentions Stras-


burg’s long fingers, which help him put nasty spins on the ball. Storen, by contrast, holds the ball deep in his smaller hand. The soft-tissue stabilizers in an elite pitcher’s shoulder must be strong and developed, but not tight like, say, a linebacker’s might be, according to Andrews, the orthopedic surgeon. The


shoulder has to stay flexible enough to reach the angles that are necessary to throw a fastball, particularly that unnatural-look- ing one when the arm is fully cocked back. Andrews is particularly known for his work with pitchers, in- cluding David Wells (elbow, 1985), Kerry Wood (elbow, 1999), Mark Prior (shoulder, 2007) and Roger Clemens (shoulder, 1985, pre-steroid allegations). Stras- burg is not one of Andrews’s pa- tients. The fact that Strasburg hasn’t


hurt his shoulder yet bodes well for his longevity as a pitcher. An- drews thinks the fact that the pitcher made it through Little League, high school and college without serious injury can be credited to his DNA. “Longevity is all genetic,” An-


drews says. “I’m sure Strasburg has great genes; not everybody has those. That’s the most critical difference between the wannabe thrower and the elite thrower.”


Turning up the heat


The most common pitcher in- juries that Andrews treats are tears to the rotator cuff, the mus- cles that stabilize the shoulder. The rotator cuff wears down from making the same violent motion so many times. To help prevent injury, the Nationals coaching staff has been limiting Strasburg to roughly 100 pitches per game; he is also to throw no more than 160 total major and minor league innings this year, meaning Stras- burg’s season will probably end before the team’s does. When Strasburg is throwing at his maximum velocity, his shoul- der rotates at about 7,500 degrees per second, according to Fleisig. That means that if Strasburg maintained his peak throwing speed for a full second, his arm would make 20 revolutions. (It only goes that fast for a split sec- ond during his windup, right be-


And it’s not going any faster. Whereas humans continue to run and swim faster than ever, we’ve apparently hit the ceiling in throwing a baseball. The shoul- der is maxed out, Andrews says. The question of who is the fast- est pitcher of all time is so con- tentious that baseball writer Tim Wendel of Vienna just wrote an entire book on the topic, “High Heat: The Secret History of the Fastball and the Improbable Search for the Fastest Pitcher of All Time.” Some people cite De- troit Tigers reliever Joel Zumaya, who was clocked at 104.8 mph on Oct. 10, 2006; others say that No- lan Ryan’s fastest pitch, 100.9 mph, was clocked at the wrong point and, had it been tested ac- curately, would have read closer to 105.9 mph. (Strasburg hits 100 mph regularly, and his average fastball clocks in at 97.2 mph.) “High Heat” ends with a list of 12 pitchers who could be the fastest, including Zumaya, Ryan and J.R. Richard. Walter Johnson, who played 100 years ago, is on the list, as is Amos Rusie, whose rookie year was 1889. Ryan came onto the scene in the mid-1960s already throwing heat, but he needed years to gain control over his pitches. Ryan compares Strasburg’s develop- ment as a pitcher with Roger Clemens’s, because neither of them was always a hard thrower. Both learned great control first; the velocity came later. (Stras- burg has referred to himself as a “late bloomer.”)


During his freshman year of


college at San Diego State, Stras- burg reined in his jumbo burrito habit and lost 30 pounds, built muscle with the team’s strength coach and took up yoga. His fast- ball gained about 10 mph. McCatty, the pitching coach, is using a hands-off approach with his young star. He worries that “too many cooks” will mess up what’s already working so well: “What am I working on? With Stephen? We go to the bullpen. I give him two baseballs and I let him throw them. And then when he’s done, I take the baseballs back.”


saslowr@washpost.com


Staff writer Dave Sheinin contributed to this report.


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