Sudden and Asymmetric Hearing Loss Among Active Duty Service Members: Underscoring the Importance of Active Screening

ABSTRACT Military personnel are at increased risk of asymmetric hearing loss secondary to noise exposure. This report illustrates the importance of expeditiously evaluating for retrocochlear pathology even in young active duty service members with asymmetric or sudden hearing loss. A 36-year-old male presented with right-sided sudden hearing loss and dizziness. Audiometry revealed profound mid-to-high-frequency sensorineural hearing loss in the right ear. A 10-day course of oral steroid therapy and two intratympanic steroid injections were unsuccessful in restoring hearing. MRI revealed a 4.2 cm contrast-enhancing cerebellopontine angle tumor, consistent with a vestibular schwannoma (VS). Microsurgical resection utilizing a retrosigmoid craniotomy approach was performed with near-total resection of the tumor and preservation of the facial nerve but not the cochlear nerve. Despite preservation of the facial nerve, progression of post-operative facial weakness required gold weight placement to prevent exposure keratopathy. The patient had recovered partial function in all facial nerve branches at last follow-up. In light of the rising global incidence of VS, any asymmetric or sudden hearing loss in military service members should be evaluated with audiometry and referral to otolaryngology for workup of retrocochlear pathology.

Incidental findings on magnetic resonance imaging of the internal auditory meatus performed to investigate audiovestibular symptoms

Objective:To determine the frequency of incidental findings found on magnetic resonance imaging scans of the internal auditory meatus performed to investigate audiovestibular symptoms, and to determine how to best manage these when found.Method:A retrospective review was conducted of internal auditory meatus magnetic resonance imaging scans during a three-month period in the radiology department at a UK district general hospital.Results:A total of 109 scans were reviewed. Of these, 92.7 per cent showed no retrocochlear pathology, 0.9 per cent showed vestibular schwannoma, 6.4 per cent revealed vascular loops, and 2.8 per cent showed incidental findings that warranted further action and investigation. Of the scans, 40.4 per cent showed other incidental pathologies such as age-related ischaemic changes, and sinus disease that required no further intervention. Of the magnetic resonance imaging scans reviewed, 49.5 per cent were entirely normal.Conclusion:Almost half of the scans investigating audiovestibular symptoms showed incidental findings. Otolaryngologists should have an understanding of the significance of the most commonly encountered incidental findings, and should counsel patients appropriately and refer them onward when necessary.