Sudden deafness and neurinoma - 15/02/11

Doi : 10.1016/j.anorl.2010.07.002

A. Chays ^a, C. Dubreuil ^b,^⁎ , F.-M. Vaneecloo ^c, J. Magnan ^d
^a Service d’ORL, CHU de Reims, rue Alexis-Carrel, 51100 Reims, France
^b Service d’otoneurochirurgie, centre hospitalier Lyon-Sud, bâtiment 3A, chemin du Petit-Revoyet, 69495 Pierre-Bénite, France
^c Service d’otologie, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France
^d Service d’ORL, hôpital Nord, chemin des Bourrelly, 13915 Marseille cedex 20, France

Corresponding author.

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Plan

Case

Questions

Question no. 1: what other examinations would you seek for this patient, who is worried by this third episode of sudden deafness? What diagnoses might you consider?

Question no. 2: this is the MRI image of the fundus of the internal auditory canal. The suggested diagnosis is, of course, “acoustic neurinoma”. What do you make of the clinical history? How do you interpret exam findings?

Question no. 3: more precisely, does the MRI image of IAC schwannoma seem to you to explain the recurrent nature of this “sudden” deafness and its ascendant aspect? If so, what mechanisms would you suggest?

Question no. 4: the patient cannot tolerate the idea of having a tumor “in the brain”, and wants treatment. What do you suggest?

Question no. 5: following this consultation, the patient opted for MRI monitoring. One year later, she was readmitted in emergency for aggravated hearing loss without signs of vertigo. Audiometry showed cophosis and left areflexia. MRI revealed a moderate increase in the size of the tumor, which was still within the IAC, which it filled completely. What is your attitude?

Question no. 6: postoperative course has been simple, without facial palsy, but the patient has lost hearing in her left ear. What would you advise, given her job and her love of music? What results would you expect from fitting a hearing aid?

Discussion

Conflict of interest statement

Text by P. Tran Ba Huy.

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Vol 128 - N° 1

P. 24-29 - janvier 2011 Retour au numéro

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