A speech discrimination test is a test using a list of 25 phonetically balanced monosyllables. It is often overlooked but significant enough for pure tone audiometry. Many physicians have performed pure tone audiometry but without a speech discrimination test. A 73-year-old woman visited our clinic complaining of sudden bilateral hearing loss. Pure tone audiometry showed only bilateral high frequency loss. However, speech discrimination had decreased markedly. We decided to follow-up after 1 week of Ginexin-F(R) (ginkgo leaf extract) and Nafril(R) (nafronyl oxalate). She felt a gait disturbance within 2 days. Magnetic resonance imaging revealed a left thalamic hemorrhage. After a 1 month hospitalization, the hematoma subsided, and speech discrimination recovered 3 months later. Acute hearing loss due to thalamic hemorrhage that recovered has never been reported. We report the first case of retrocochlear hearing loss that occurred with a thalamic hemorrhage in a patient who recovered.
Aged ; Audiometry ; Female ; Follow-Up Studies ; Gait ; Hearing Loss ; Hearing Loss, Bilateral ; Hematoma ; Hemorrhage* ; Hospitalization ; Humans ; Magnetic Resonance Imaging ; Retrocochlear Diseases* ; Speech Discrimination Tests ; Speech Perception ; Thalamus

BACKGROUND AND OBJECTIVES: Unilateral auditory dysfunction such as tinnitus and hearing loss could be a warning sign of a retrocochlear lesion. Auditory brainstem response (ABR) and internal auditory canal magnetic resonance image (MRI) are suggested as novel diagnostic tools for retrocochlear lesions. However, the high cost of MRI and the low sensitivity of the ABR test could be an obstacle when assessing patients with unilateral ear symptoms. The purpose of this study was to introduce the clinical usefulness of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) MRI in patients with unilateral ear symptoms. SUBJECTS AND METHODS: Two hundred and fifty-three patients with unilateral tinnitus or unilateral hearing loss who underwent 3D-FIESTA temporal bone MRI as a screening test were enrolled. We reviewed the abnormal findings in the 3D-FIESTA images and ear symptoms using the medical records. RESULTS: In patients with unilateral ear symptoms, 51.0% of the patients had tinnitus and 32.8% patients were assessed to have sudden sensory neural hearing loss. With 3D-FIESTA imaging, twelve patients were diagnosed with acoustic neuroma, four with enlarged vestibular aqueduct syndrome, and two with posterior inferior cerebellar artery aneurysm. Inner ear anomalies and vestibulocochlear nerve aplasia could be diagnosed with 3D-FIESTA imaging. CONCLUSIONS: 3D-FIESTA imaging is a highly sensitive method for the diagnosis of cochlear or retrocochlear lesions. 3D-FIESTA imaging is a useful screening tool for patients with unilateral ear symptoms.
Aneurysm ; Arteries ; Diagnosis ; Ear ; Ear, Inner* ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss ; Hearing Loss, Unilateral ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Medical Records ; Methods ; Neuroma, Acoustic ; Retrocochlear Diseases ; Temporal Bone ; Tinnitus ; Vestibular Aqueduct ; Vestibulocochlear Nerve

BACKGROUND AND OBJECTIVES: There are many audiological tests to distinguish between the hearing loss patients of cochlear lesion and the retrocochlear lesion. We started this research to compare the efficacy of the audiological tests and to make helpful selections of the auditory hearing tests in diagnosis of the sensorineural hearing loss patients. MATERIALS AND METHOD: Our study was conducted on 198 patients with hearing loss. They received otologic physical examination, neurological examination, and MRI. We evaluated SISI, STAT, ARDT, DPOAE, and ABR data values and analysed their sensitivity and specificity. RESULTS: Sensitivity of SISI was 55% and specificity was 74%. Sensitivity of STAT was 58% and specificity was 67%. Sensitivity of ARDT was 44% and specificity was 71%. Sensitivity of DPOAE was 50% and specificity was 64%. Sensitivity of ABR was 90% and specificity was 74%. CONCLUSION: Among the tests performed above, ABR showed the highest sensitivity and specificity value, which implies it to be the most meaningful screening test in the sensorineural hearing loss patients. But for the patients with severe hearing loss, such that the auditory hearing test results are suspicious in its accuracy, or for the patients who are suspicious of retrocochlear lesions based upon multiple tests, MRI should be performed to make the final diagnosis.
Diagnosis ; Diagnosis, Differential* ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Tests ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Neurologic Examination ; Physical Examination ; Retrocochlear Diseases* ; Sensitivity and Specificity