Sudden hearing loss in acoustic neuroma patients

Abstract

Patients with acoustic neuroma may have sudden sensorineural hearing loss. Most patients with sudden hearing loss seek medical attention promptly, but the diagnosis of an acoustic neuroma may be delayed for months or years because sudden hearing loss is an unusual initial symptom of an acoustic neuroma. In a retrospective review of 836 cases of sudden hearing loss, we found 13 patients with acoustic neuromas. The prevalence of acoustic neuromas for those screened with auditory brain stem response or magnetic resonance imaging was 2.5%. In addition to these 13 patients, 79 acoustic neuroma patients treated in our clinic had well-documented sudden hearing loss as the initial symptom. Hearing loss in these 92 patients ranged from mild to profound. Associated symptoms of pain, facial paresthesia, or unilateral tinnitus preceding the sudden hearing loss were suggestive of an acoustic neuroma, as was a midfrequency (U-shaped) hearing loss. A history of other diseases or events that might explain the sudden hearing loss, a normal electronystagmogram, or recovery of hearing does not eliminate the possibility of a tumor. Because there are no clinical findings that clearly distinguish those patients with acoustic neuromas from other patients with sudden hearing loss, we recommend either an evaluation with auditory brain stem response or gadolinium-enhanced magnetic resonance imaging for any patient with sudden hearing loss.

Clinical Practice Guideline

“…Tinnitus in the affected ear prior to the onset of the SHL, associated otalgia, or paresthesias are more common in patients with vestibular schwannoma; however, these symptoms are too rare for their absence to reliably rule out a retrocochlear lesion. Although the risk of underlying tumor is lower in patients with low‐frequency hearing loss, all types of audiometric patterns have been found in SSNHL patients with vestibular schwannomas 4,97 …”

“…Moreover, nonidiopathic causes of SSNHL must be identified and addressed during the course of management; the most pressing of these are vestibular schwannoma (acoustic neuroma), stroke, and malignancy. 4 Up to 90% of SSNHL, however, is idiopathic at presentation and is presumptively attributed to vascular, viral, or multiple etiologies. 5 A maximum of 32% to 65% of cases of SSNHL may recover spontaneously.…”

Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary

“…The distinction between SSNHL and sudden conductive or mixed hearing loss is one that should be made by the initial treating health care provider in order for early diagnosis and management to be instituted. Moreover, nonidiopathic causes of SSNHL must be identified and addressed during the course of management; the most pressing of these are vestibular schwannoma (acoustic neuroma), stroke, malignancy, noise, and ototoxic medications 6–9 …”

“…Moreover, nonidiopathic causes of SSNHL must be identified and addressed during the course of management; the most pressing of these are vestibular schwannoma (acoustic neuroma), stroke, malignancy, noise, and ototoxic medications. [6][7][8][9] Much of the literature indicates that 32% to 65% of cases of SSNHL may recover spontaneously. 4,10 Clinical experience, however, shows that these numbers may be an overestimation.…”

“…1ENT &8 Consumers United for Evidence-based Healthcare (CUE), Baltimore, Maryland, USA;9 Ear, Nose & Throat Specialists of Northern Virginia, P.C., Manassas, Virginia, USA;10 Gould Medical Group-Otolaryngology, Stockton, California, USA;11 Columbia University Medical Center, New York, New York, USA;12 Mayo Clinic, Rochester, Minnesota, USA;13 StachlerENT, West Bloomfield, Michigan, USA;14 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.Corresponding Author: Sujana S. Chandrasekhar, MD, ENT & Allergy Associates, LLP, 18 East 48th Street, New York, NY 10017, USA. Email: ssc@nyotology.com s KAS 10: Intratympanic steroid therapy for salvage is recommended within 2 to 6 weeks following onset of sudden sensorineural hearing loss.…”