Hipoacusia súbita neurosensorial como síntoma inicial de schwannoma vestibular

Abstract

Introduction and objective: Sudden unilateral sensorineural hearing loss (SNH) poses a differential diagnosis with multiple pathologies. Vestibular schwannoma (SV) is one of them in up to 5% of cases. We describe 3 clinical cases diagnosed in our center.Method: A retrospective study of patients diagnosed with sudden hearing loss in our center for 17 years was carried out and those cases that finally presented vestibular schwannoma after completing imaging tests were described.Results: A total of 230 patients were registered, of which only 3 were subsequently diagnosed with VS. All of them received treatment with oral corticosteroids and hyperbaric oxygen without any improvement. Magnetic resonance imaging (MRI) was performed around a month after the episode, confirming the diagnosis. The first patient was a 61-year-old man with a history of moderate sensorineural hearing loss who presented clinical signs of vertigo due to vestibular hypofunction and right cophosis and who required surgical treatment. The second was a 49-year-old man with symptoms of moderate right-sided hearing loss in acute cases, without vestibular involvement, who was diagnosed with VS, Koos grade 1 according to MRI, and received radiosurgery treatment, with no subsequent growth. The last patient was a 25-year-old man with acute moderate right sensorineural hearing loss who presented SV grade Koos 3 according to MRI and received surgical treatment.Discussion: Sudden sensorineural hearing loss may be the debut symptom, and even the only symptom presented, by patients with vestibular schwannoma. Advances in imaging tests have made it possible that today the definitive test for the diagnosis of VS is MRI, especially the T1 sequence with gadolinium contrast, being possible to objectify even the smallest; For this reason, the current guidelines for the management of sudden hearing loss recommend performing this test to avoid diagnostic delay despite the good response with corticosteroid treatment. Although this is not the case with our patients, we must consider that, contrary to what may initially be thought, the improvement after treatment does not exclude the diagnosis of VS.Conclusions: Sudden sensorineural hearing loss may be the main symptom of VS manifestation in up to 1.3% of HSN cases in our study. This pathology should be treated as an otological emergency and corticosteroid treatment as well as MRI should be performed.