Sudden sensorineural hearing loss as the initial symptom in patients with acoustic neuroma

Abstract

BackgroundPrevious studies have shown that patients with acoustic neuroma (AN) sometimes present with sudden sensorineural hearing loss (SSNHL) as an initial symptom. The purpose of this research was to investigate the clinical characteristics, diagnosis, and treatment of AN in patients initially diagnosed with SSNHL.Materials and methodsWe reviewed retrospectively the medical records of all patients who were treated as SSNHL initially and were later diagnosed with AN after undergoing magnetic resonance imaging (MRI) at our hospital between 2008 and 2021. Patient demographics, associated complaints (mostly tinnitus and vertigo), the severity of hearing loss, audiogram configurations, auditory brainstem response (ABR), and MRI examination were reviewed and analyzed. In addition, treatment outcomes and management protocols were also included in this study.ResultsA total of 10 (0.7%, 10/1,383) patients presented with SSNHL as the initial symptom and were diagnosed as AN by MRI finally. Of the 10 patients enrolled in this study, four were men and six were women. The average age at the time of diagnosis of SSNHL was 46.2 ± 13.16 years. These patients exhibited varying severity of hearing loss and a variety of audiogram configurations. All patients showed an abnormal ABR. According to the Koos grading standard, there were 5 grade I (intracanalicular [IAC]) tumors, 3 grade II tumors, and 2 grade III tumors. The treatment outcome revealed that 2 patients exhibited recovery of the average hearing of impaired frequency by more than 15 dB, and 6 patients showed no recovery. Furthermore, four patients were referred to undergo surgical treatment after being diagnosed with AN, 1 patient accepted stereotactic radiation therapy, and the remaining 5 patients were on a “wait and scan” strategy.ConclusionThe hearing loss of patients with AN presented with SSNHL may improve with drug treatment. Hearing recovery for SSNHL does not exclude the presence of AN, and all patients initially diagnosed with SSNHL should undergo MRI and ABR to prevent misdiagnosis and delays in potential treatment.

Steroid Efficacy on Audiologic Recovery in Patients With Sudden Sensorineural Hearing Loss and Vestibular Schwannoma: A Retrospective Review

“…These benign tumors often present as unilateral sensorineural hearing loss, vertigo, or tinnitus, with up to one in five patients with VS reporting SSNHL at some point in their medical history (6,8,9). For patients initially presenting with SSNHL, however, the incidence of VS has remained between 0.5 and 5%, which our study's findings reinforce (5,9,10,12–17). Although the exact mechanism of how patients with VS present with SSNHL remains unclear (2), hypotheses have included conductive blocks or compression within the cochlear nerve (18), inflammatory responses to the tumor (19), infection (2), and vascular insufficiency (20).…”

“…Sudden sensorineural hearing loss (SSNHL), defined as rapid-onset sensorineural loss of ≥30 dB across three frequencies on audiogram, has a reported an incidence rate of 5-20 per 100,000 people in the United States (1)(2)(3). The vast majority of SSNHL cases are idiopathic, with about 10% yielding an associated diagnosis, including neoplasm, systemic disease, or other otologic pathology (2,(4)(5)(6).…”

“…Vestibular schwannomas (VS) are slow-growing benign tumors of the vestibular branch of the vestibulocochlear nerve within the internal auditory canal (5,7). Although these patients often present with progressive unilateral sensorineural hearing loss, tinnitus, and vertigo, a small portion may present with isolated SSNHL (6)(7)(8)(9).…”

The Outcome of the Retrosigmoid approach in the Vestibular Schwannomas decompression, A Retrospective Cohort Study of 60 consecutive cases

“…This loss may be related to the size of the tumor [10,11]. It has also been reported that the loss appears progressively in more than 90% of cases, but it can also occur suddenly [9,10,11,12]. Interestingly, some authors report that sudden hearing loss due to VS accounts for 4% of all cases of sudden sensorineural hearing loss (SSNHL) [13].…”

Referral patterns and gaps in financial coverage hinder appropriate treatment of Sudden Sensorineural Hearing Loss (SSNHL) with Hyperbaric Oxygen Therapy (HBOT).

“…More than 90% of cases are idiop -athic and the remainder are due to causes such as acoustic neuroma, stroke, malignancy, Meniere's disease, trauma, autoimmune disease or infection. (21) Due to the unclear etiology for the onset of sudden hearing loss, the condition is difficult to treat. Treatment that has been recommended includes the use of agents to decrease blood viscosity, drugs and procedures designed to induce vasodilation, anticoagulants, antiviral agents, free radical scavenging vitamins, antibiotics, corticosteroids and hyperbaric oxygen therapy.…”