Bilateral deafness of vascular origin.

Abstract

REPORTS of bilateral lesions causing auditory deficit in man are infrequent. 1 In 1967, for example, Jaffe reported 4 patients with bilateral deafness among 143 patients who developed sudden sensorineural hearing loss.1 Deafness of vascular etiology is stated to occur unilaterally and permanent impairment of hearing is a frequent sequel.3 In this paper we describe 2 patients with reversible, sudden bilateral deafness of vascular origin. Patient 1At age 50, a hypertensive black man developed dizzy spells. These spells occurred irregularly, 3 to 4 times a day and lasted 3-4 minutes. They were described as a "feeling of being drunk" and were associated with low-pitched tinnitus and slurred speech. Neurological examination, including visual fields and optokinetic nystagmus, was normal. Electronystagmography was normal and audiometry revealed mild, bilateral, high frequency sensorineural hearing loss with good speech discrimination (see table). He was prescribed aspirin. Two months later he complained of aggravation of episodic dizziness, double vision, numbness marching down the left arm and band-like headaches while using the right hand for painting walls and ceiling. His blood pressure was 110/80 mm Hg in both arms; the patient being on thiazide diuretics and potassium supplement. Neurological examination was again normal. Roentgenograms of the skull revealed calcification of the basilar artery posterior to the clivus and of the carotids overlying the sella turcica. Brain scan, electroencephalogram and arch aortogram were normal. Cerebrospinal fluid examination, including glucose and protein values, was also normal.Two weeks later, after having used the bathroom, the patient suddenly felt vertiginous with a tendency to fall either sideways, forward or backward. He complained of roaring in both ears and deafness. He denied dysarthria, dysphagia, diplopia, focal weakness, sensory loss, or loss of consciousness. General physical examination was normal. Neurological ex- amination disclosed an alert individual with normal higher cortical functions. Examination of cranial nerves revealed bilateral counterclockwise rotatory nystagmus as well as vertical nystagmus, both accentuated upon standing. He had bilateral hearing loss, right greater than left; and cold caloric stimulation of the left ear caused nystagmus to the right while the right ear stimulation produced no response. Examination of the motor and sensory systems, including plantar responses, were normal. His station was broadbased and ataxic, with a tendency to fall to the left. Tests of coordination revealed an intention tremor of the left upper extremity. Laboratory data on admission included normal results of complete blood count, electrolytes, glucose and electrocardiogram.Selective cerebral angiography showed normal carotid circulation. The arch study revealed marked stenosis of the right vertebral artery at its origin but this artery could not be selectively catheterized. Selective angiography of the left vertebral artery showed significant stenosis with m...

Sudden bilateral hearing impairment in vertebrobasilar occlusive disease.

“…However, the IAA may have variable origins and anastomoses 5,16 When the proximal IAA is occluded, the cochlea is less involved because adequate collateral circulation may develop. Because four of seven patients in this series were in the locked-in state, SBHI in vertebrobasilar occlusive stroke seems to foretell a grave prognosis.…”

“…Although hearing loss has been reported in patients with brain stem stroke,3,4 only a few patients had sudden bilateral hearing impairment (SBHI). [5][6][7] We report seven patients with SBHI in VBOD seen during the past 5 years, four of whom progressed to a locked-in state. Recognition of this early symptom may help lead to correct diagnosis and proper management.…”

A practical approach to acute vertigo

“…The advent of neuroimaging, particularly MRI, has allowed an appreciation that sudden hearing loss can occasionally occur in brainstem strokes 36 – 44. As this hearing loss is almost always accompanied by vertigo, a purely peripheral syndrome may be initially considered but the associated brainstem signs in almost every case would suggest central involvement 40.…”

“…Occasionally the hearing loss can be due to a central lesion affecting crossing auditory pathways (lateral lemniscus) of the contralateral dorsolateral upper pons 41. Additionally, bilateral hearing loss has been reported with vertebrobasilar ischaemia 36, 40…”

Neuro-otological emergencies

“…The advent of neuro-imaging allowed an appreciation that sudden hearing loss could accompany stroke [39][40][41][42] but until recently there were no prospective studies. Lee and Baloh [43 ] characterized the phenomenology of stroke in 364 patients with vertebrobasilar ischaemia with reference to acute hearing loss.…”