Clinical Vignette

A previously healthy 42-year-old Army chaplain noted that he could no longer hear well on the telephone using his left ear or understand a colleague when there was much ambient noise particularly from other conversations. In retrospect, he had experienced mild progressive ringing in this ear. Initially this was attributed to chronic loud noise exposure while assigned to an artillery brigade. Although this gradually worsened over several years, it was not until his telephone difficulties led him to test himself that he found he could no longer appreciate the sound of a watch ticking. He was otherwise totally well. His only abnormal finding on neurologic examination was grossly diminished hearing in his left ear.

Audiometric examination revealed markedly decreased high-frequency appreciation and diminished speech discrimination in his left ear. Gadolinium MRI demonstrated a homogeneously enhancing 2 x 1.5-cm mass within the left cerebellar pontine angle. This emanated from his internal auditory canal and was associated with mild pontine distortion.

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  • Category: Nervous diseases