Acoustic Neuroma in Patients with Completely Resolved Sudden Hearing Loss

2003 ◽  
Vol 112 (5) ◽  
pp. 395-397 ◽  
Author(s):  
Ben I. Nageris ◽  
Aaron Popovtzer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Brain Stem ◽  
Complete Recovery ◽  
Sudden Hearing Loss ◽  
Resonance Imaging ◽  
Auditory Brain Stem ◽  
Acoustic Tumor ◽  
Brain Stem Evoked Response

Approximately 30% of patients with sudden hearing loss show complete recovery. Researchers have long questioned whether extensive evaluation is necessary in these cases. Recently, however, with the increasing widespread application of magnetic resonance imaging, a higher rate than expected of acoustic neuromas has been detected in patients with sudden hearing loss. Two studies have suggested that affected patients may even partially regain hearing. The aim of the present clinical study was to determine whether acoustic neuroma–induced hearing loss may be associated with full recovery. The files of 67 patients evaluated for sudden hearing loss at Rabin Medical Center from 1989 to 2000 were reviewed. All patients underwent pure tone audiometry, acoustic reflex tests, and auditory brain stem evoked response tests. Hearing evaluation was followed by magnetic resonance imaging scan and, 1 month later, a second hearing test. Findings were compared between patients with and without evidence of tumor on imaging, and between patients with tumor with and without full recovery. Twenty-four patients (36%) had a diagnosis of acoustic tumor, of whom 4 (16.7%) recovered hearing after 1 month. All 4 tumors were intracanalicular. Two of these patients had low-tone hearing loss, and 2 had flat curves; 3 had a pathological auditory brain stem evoked response. Of the 43 patients without tumors, 26 (60%) showed complete resolution of the hearing loss. We conclude that complete recovery of hearing loss does not exclude acoustic tumor, and these patients therefore require full evaluation. The reason for the recovery remains unclear.

Presentation and Diagnosis of Small Acoustic Tumors

1994 ◽  
Vol 111 (3P1) ◽  
pp. 232-235 ◽  
Author(s):  
John L. Dornhoffer ◽  
Jan Helms ◽  
Dirk H. Hoehmann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Retrospective Study ◽  
Magnetic Resonance ◽  
Brain Stem ◽  
Clinical Presentation ◽  
Resonance Imaging ◽  
Auditory Brain Stem Response ◽  
Auditory Brain Stem ◽  
Brain Stem Response

With the recent advent of magnetic resonance imaging and auditory brain stem response, it is now possible to diagnose acoustic tumors while they are still quite small. As a result, it is becoming obvious that the clinical presentation of these smaller lesions can be somewhat variant to what is considered typical for an acoustic neuroma. Likewise, although the sensitivity of auditory brain stem response for larger tumors is believed to be quite good, the sensitivity for smaller tumors has recently been questioned, particularly when the patient is first seen early in the course of the disease with only mild otologic complications. To assess auditory brain stem response results as well as clinical and audiologic presentations, we conducted a retrospective study of patients treated for small acoustic tumors (less than 1 cm). Of the 70 patients included in the study, auditory brain stem response was abnormal in 65 (93%), on the basis of wave V latency prolongation and interaural latency differences. This would indicate that auditory brain stem response is a valid screening test for acoustic tumors, even in early stages of development. The clinical presentation of patients with small acoustic tumors was similar to that reported for acoustic tumors in general, but with vertigo occurring more frequently in patients with smaller tumors. Several atypical patterns of hearing loss were also noted.

Significance of Auditory Brain Stem Response and Gadolinium-Enhanced Magnetic Resonance Imaging for Idiopathic Sudden Sensorineural Hearing Loss

1995 ◽  
Vol 113 (3) ◽  
pp. 271-275 ◽  
Author(s):  
Nicolas Y. Busaba ◽  
Steven D. Rauch
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Sensorineural Hearing Loss ◽  
Brain Stem ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Resonance Imaging ◽  
Auditory Brain Stem Responses ◽  
Auditory Brain Stem

Previous studies tried to correlate prognosis and response to oral corticosteroids in patients with idiopathic sudden sensorineural hearing loss to such factors as the age of the patient, presence of vertigo, shape of the audiogram, or severity of the hearing loss. However, temporal bone histopathologic evidence shows that idiopathic sudden sensorineural hearing loss may be caused by cochleitis or cochlear nerve neuritis. Herein we report results of a retrospective study of 96 consecutive patients with idiopathic sudden sensorineural hearing loss who were evaluated with auditory brain stem responses and gadolinium-enhanced magnetic resonance imaging. Results of the auditory brain stem response and magnetic resonance imaging were correlated with hearing outcome. Follow-up was available for 65 patients: 14 with abnormal and 51 with normal auditory brain stem responses. The overall rate of hearing recovery or improvement was 65% in the normal auditory brain stem response group compared with 43% in the abnormal auditory brain stem response group ( p = 0.07). Among the 38 patients treated with a tapering course of oral corticosteroids, the recovery or improvement rate was 83% for those with normal auditory brain stem responses and 56% for those with abnormal auditory brain stem responses ( p < 0.05). Of the 27 patients who did not receive steroid therapy, the improvement rate was 41% in those with normal auditory brain stem responses and 20% in those with abnormal auditory brain stem responses ( p = 0.09). Magnetic resonance imaging with gadolinium was obtained on all 14 patients with abnormal auditory brain stem responses but on none with normal auditory brain stem responses. Only 1 magnetic resonance image of 14 demonstrated an abnormality, showing a high signal intensity in the distal internal auditory canal; this resolved 6 weeks later on a follow-up magnetic resonance image. We conclude that idiopathic sudden sensorineural hearing loss patients with abnormal auditory brain stem responses have poorer hearing prognoses compared with those patients with normal auditory brain stem responses, irrespective of treatment. Idiopathic sudden sensorineural hearing loss patients with abnormal auditory brain stem responses may have cochlear neuritis causing their hearing loss or may have a more extensive involvement of their auditory system, and this “lesion” may have a lower spontaneous recovery rate and less response to therapy. Magnetic resonance imaging with gadolinium may show abnormal signal intensities along the course of the eighth nerve in patients with idiopathic sudden sensorineural hearing loss, but this is infrequent, and its prognostic implications are not clear.

Deafness after Bilateral Midbrain Contusion: A Correlation of Magnetic Resonance Imaging with Auditory Brain Stem Evoked Responses

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 106-109 ◽  
Author(s):  
Niranjan N. Jani ◽  
Robert Laureno ◽  
Alexander S. Mark ◽  
Carmen C. Brewer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Stem ◽  
Head Trauma ◽  
Closed Head Injury ◽  
Evoked Responses ◽  
Resonance Imaging ◽  
Focal Lesions ◽  
Auditory Brain Stem ◽  
Objective Evidence

Abstract A 46-year-old woman became deaf after a closed head injury. When a computed tomographic scan failed to disclose the cause, conversion disorder was suspected. Magnetic resonance imaging, however, showed bilateral contusions of the inferior colliculi, providing objective evidence for an organic cause of hearing loss. Auditory brain stem evoked responses and stapedial reflexes also provided objective evidence of brain stem injury. This case illustrates the phenomenon of dorsal midbrain injury after head trauma. It indicates the sensitivity of magnetic resonance imaging for small focal lesions after head trauma, and it demonstrates some difficulties in the diagnosis of “hysterical” deafness. (Neurosurgery 29:106-109, 1991)

Magnetic Resonance Imaging in Patients with Sudden Hearing Loss, Tinnitus and Vertigo

2001 ◽  
Vol 22 (6) ◽  
pp. 808-812 ◽  
Author(s):  
Bernhard Schick ◽  
Dominik Brors ◽  
Oliver Koch ◽  
Maria Sch??fers ◽  
Gabriele Kahle
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Sudden Hearing Loss ◽  
Resonance Imaging

scholarly journals Unilateral tinnitus as a single symptom of unusually large vestibular schwannoma

2014 ◽  
Vol 67 (suppl. 1) ◽  
pp. 46-48
Author(s):  
Zoran Komazec ◽  
Slobodanka Lemajic-Komazec ◽  
Rajko Jovic ◽  
Ljiljana Vlaski ◽  
Dragan Dankuc
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Sensorineural Hearing Loss ◽  
Brain Stem ◽  
Vestibular Schwannoma ◽  
Sensorineural Hearing ◽  
Magnetic Resonance Imaging Examination ◽  
Resonance Imaging ◽  
Persistent Symptoms

Introduction. Vestibular schwannomas are relatively rare tumors whose symptoms are based on its location and as the tumor grows, the symptoms usually advance. Case Report. An 18-year old patient was examined by an otolaryngologist due to buzzing in her right ear that had lasted for about 1 month. Her pure-tone audiometry findings showed slight asymmetry; a slight ascendant type sensorineural hearing loss was found in the right ear (25 dB HL at 125 Hz, 20 dB HL at 250 Hz, and 10 dB HL at other frequencies), while the threshold in the left ear was 15 dBHL at 125 Hz and 10 dB HL at other frequencies. Electronystagmography, otoacoustic emissions and auditory brain-stem responses suggested retrocochlear etiology of tinnitus. Magnetic resonance imaging examination revealed a large right cerebellopontine angle tumor, measuring 5 x 3 x 3 cm, which had shifted the brain stem laterally. Conclusion. Every case of unilateral tinnitus, asymmetric sensorineural hearing loss, or hypotonia of labyrinth not strictly accompanied by vertigo, needs to be further evaluated using a battery of audiologic tests whose findings may be normal. Audiologic tests should be repeated in cases of persistent symptoms and accompanied by cranial magnetic resonance imaging, which is today considered the gold standard for diagnosis of vestibular schwannoma.

scholarly journals The ‘full-blown’ MRI of sudden hearing loss: 3D FLAIR in a patient with bilateral metastases in the internal auditory canals

2017 ◽  
Vol 31 (1) ◽  
pp. 39-41 ◽  
Author(s):  
Giorgio Conte ◽  
Federica Di Berardino ◽  
Diego Zanetti ◽  
Sabrina Avignone ◽  
Clara Sina ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Internal Auditory Canal ◽  
Sudden Hearing Loss ◽  
Resonance Imaging ◽  
Recovery Sequence ◽  
Fluid Attenuated Inversion Recovery ◽  
Bilateral Metastases ◽  
3D Flair

We report a case of a 57-year-old man with bilateral masses in the internal auditory canal. The peculiar findings at magnetic resonance imaging with tridimensional fluid-attenuated inversion recovery sequence combined with clinical data provided new insights into understanding the pathophysiology of the hearing loss.

Cost-Effective Evaluation of Asymmetric Sensorineural Hearing Loss with Focused Magnetic Resonance Imaging

1997 ◽  
Vol 116 (6) ◽  
pp. 567-574 ◽  
Author(s):  
David A. Carrier ◽  
Moises A. Arriaga
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Sensorineural Hearing Loss ◽  
Brain Stem ◽  
Cost Effective ◽  
Sensorineural Hearing ◽  
Resonance Imaging ◽  
Asymmetric Sensorineural Hearing Loss ◽  
Brain Stem Response

The poor sensitivity of audiometric brain stem response for small vestibular schwannomas (acoustic neuromas) creates a dilemma for the physician evaluating a patient with signs and symptoms of retrocochlear disease. Magnetic resonance imaging is recognized as the gold standard for the evaluation of these problems, but if a complete examination of the internal auditory canals and head is done on every patient, the cost is high. Although less expensive, screening with audiometric brain stem response risks missing up to 33% of small tumors. Therefore we developed a focused magnetic resonance imaging sequence for evaluation of patients with asymmetric sensorineural hearing loss and/or nonpulsatile tinnitus. The protocol includes a T1-weighted sagittal localizer, pregadolinium and post-gadolinium T1-weighted 3-mm contiguous axial slices through the internal auditory canal and the region of the cerebellopontine angle, and T2-weighted axial images through the entire brain. Total scanning time is about 12 minutes, and the estimated cost is $300 to $500. We retrospectively reviewed the imaging records of 485 screening examinations done during an 18-month period. Twenty-four patients had diagnoses definitely or probably producing the hearing loss for an overall positive rate of 5%. By eliminating the need for follow-up audiometric or electrophysiologic studies, we believe a focused magnetic resonance imaging-based diagnostic scheme is actually more cost-effective on a cost-per-patient basis.

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