Vol.100 No.10 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 100 No. 10 October 2007
Three Cases of Hearing Loss Diagnosed as Acute Low-Tone
Senseorineural Hearing Loss at the First Visit
Shun-ichi Imamura
(Yamanashi University, Suwa Central Hospital)
Masanori Miyata, Akihito Mizukoshi and Keisuke Masuyama
(Yamanashi University)
Recently, it was shown that acute low-tone sensorineural hearing loss (ALHL) can be recurrent and occasionally associated with Menieres disease. However, it is thought to be extremely rare for ALHL to progress to severe hearing loss. The diagnosis of ALHL is based on hearing symptoms showing an acute onset and pure-tone audiometry findings at the first examination. Based on these criteria, the possibility of other diseases being diagnosed as ALHL during their clinical course is as predictable as in that of sudden hearing loss.
We report three cases that were compatible with a diagnosis of ALHL at the first visit, but were finally diagnosed as various other disorders on further clinical observation and examination.
Case 1 experienced multiple attacks of low-tone hearing loss, and achieved recovery after steroid treatment. Then she showed bilateral progressive hearing loss that reached the middle and high tone. This case finally developed severe bilateral hearing loss and was diagnosed as idiopathic bilateral sensorineural hearing loss. Case 2 experienced a couple of recurrences followed by recovery of hearing. Then she additionally complained of dizziness and headache in a standing position during the third recurrences. Her complaints disappeared following epidermal blood patch performed three times by a neurosurgeon under a diagnosis of intracranial hypotension syndrome. Case 3 obtained complete recovery, however screening MRI indicated acoustic neurinoma in the inner ear meatus.
Our literature review indicated that perilymph fistula, genomic hearing loss and some other disorders also might be diagnosed as ALHL at the initial stage. Some cases diagnosed as ALHL, showing an atypical course such as the development of severe hearing loss and vestibular dysfunction, may actually be other hearing disorders. At the initial diagnosis and follow up of ALHL, the possibility of the disorders described above should be considered.
Key words : idiopathic bilateral sensorineural hearing loss, intracranial hypotension syndrome, acoustic neurinoma