SUDDEN HEARING-LOSS IN ACOUSTIC NEUROMA PATIENTS

Patients with acoustic neuroma may have sudden sensorineural hearing l oss. Most patients with sudden hearing loss seek medical attention pro mptly, but the diagnosis of an acoustic neuroma may be delayed for mon ths or years because sudden hearing loss is an unusual initial symptom of an acoustic neuroma, In a retrospective review of 836 cases of sud den hearing loss, we found 13 patients with acoustic neuromas. The pre valence of acoustic neuromas for those screened with auditory brain st em response or magnetic resonance imaging was 2.5%. In addition to the se 13 patients, 79 acoustic neuroma patients treated in our clinic had well-documented sudden hearing loss as the initial symptom. Hearing l oss in these 92 patients ranged from mild to profound. Associated symp toms 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 e vents that might explain the sudden hearing loss, a normal electronyst agmogram, or recovery of hearing does not eliminate the possibility of a tumor. Because there are no clinical findings that clearly distingu ish those patients with acoustic neuromas from other patients with sud den hearing loss, we recommend either an evaluation with auditory brai n stem response or gadolinium-enhanced magnetic resonance imaging for any patient with sudden hearing loss.