R. NICKBRYANMDS. JAMESZINREICHMD
A 51-YEAR-OLD woman presented with left-sided aural fullness of several weeks' duration. She also reported occasional tinnitus and progressive decline in her hearing on the left side. She did not complain of disequilibrium, headache, otalgia, otorrhea, vertigo, or facial nerve dysfunction. She denied any history of head trauma, ear surgery, family history of hearing loss, tuberculosis, or exposure to ototoxic medications. The findings of otoscopy and a cranial nerve examination were normal. Cerebellar testing revealed no deficits. The patient demonstrated mild gaze instability with left head thrusts, consistent with vestibular hypofunction. Audiologic testing, which was performed with insert ear phones, revealed normal hearing sensitivity in the right ear and normal hearing at 250 to 750 Hz, dropping sharply to severe sensorineural hearing loss at 1000 Hz and then rising again to the mild range, in the left ear. There was no word recognition ability in the left ear. The findings of auditory brainstem response audiometry were abnormal. Magnetic resonance imaging (MRI) was subsequently performed, and the results are shown in Figure 1 and Figure 2.
Frelinghuysen P, Niparko JK. Imaging Quiz Case 2. Arch Otolaryngol Head Neck Surg. 1998;124(7):815-819. doi:10.1001/archotol.124.7.814