Extended High Frequency Audiometry for Revealing Sudden Sensory Neural Hearing Loss in Acute Tinnitus Patients

Introduction The measurement of extended high-frequency (EHF) audiometry has become more popular recently, mainly in connection with ototoxicity and noise-induced hearing loss. New-onset tinnitus evaluation includes a standard hearing test that shows no pathology. Objective The aim of the present study was to evaluate the possibility that acute tinnitus is essentially connected to sudden sensory neural hearing loss (SSNHL), by utilizing EHF audiometry in cases in which standard audiometry for frequencies between 8 kHZ to 8000 Hz is within normal limits. Methods A retrospective study was conducted between January 2009 and May 2014 that included all patients presenting with acute tinnitus and normal standard audiometry. All patients underwent EHF audiometry and were treated accordingly. Results Thirty-two patients with acute tinnitus and asymmetric sensorineural hearing loss on EHF audiometry were identified. The average deltas between the ears were between 9.2 and 33 dB (worse in the affected ear). Conclusion Extended high-frequency audiometry up to 20,000 Hz should be performed in all patients with acute tinnitus and standard audiometry within normal limits.

A Trigeminal Schwannoma Masked by Solely Vestibulocochlear Symptoms

Background Intracranial schwannomas are most commonly associated with the vestibulocochlear nerve, often leading to hearing loss, tinnitus, and vestibular dysfunction. Much less often, a schwannoma can arise from the trigeminal nerve which can lead to facial pain, numbness, and weakness. Purpose We explored a case of a patient with an magnetic resonance imaging (MRI)-confirmed trigeminal schwannoma that was mistaken for a vestibulocochlear schwannoma because of a myriad of ipsilateral vestibulocochlear symptoms. Research Design This is a retrospective chart review and case study, with no statistics applied. Results This diagnostic error led to clinical confusion and inaccurate medical record-keeping. Radiologists and radiation oncologists deemed the patient's symptoms to be unrelated to the asymptomatic trigeminal schwannoma, and she was referred to an otolaryngologist following complaints of ear fullness, ear pain, and hearing loss. The patient's audiogram showed ipsilateral, asymmetric sensorineural hearing loss, and she was diagnosed with concurrent Meniere's disease. Alternative explanations, such as an additional schwannoma or external compression of the vestibulocochlear nerve, were considered, but not apparent on MRI. Conclusions From this case, we see that symptoms do not always concur with imaging results and that multiple etiologies, especially when one is rare, can confuse a clinical picture.