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Normal audiologic presentations in patients with acoustic neuroma: An evaluation using strict audiologic parameters
D D Magdziarz1, R J Wiet, E A Dinces
1Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, Illinois, USA.
Summary
Acoustic neuromas can present with normal hearing, challenging diagnosis. Magnetic resonance imaging is crucial for detecting these tumors when auditory brainstem response tests are negative.
Area of Science:
- Neurology
- Audiology
- Neurosurgery
Background:
- Acoustic neuromas are tumors that can affect hearing.
- Previous studies noted normal audiologic parameters in some acoustic neuroma cases.
- This study focuses on cases with exceptionally stringent normal hearing criteria.
Purpose of the Study:
- To investigate acoustic neuroma cases with strictly normal hearing.
- To evaluate the sensitivity of audiological tests in detecting acoustic neuroma with normal hearing.
- To determine the most effective diagnostic tool for acoustic neuroma in this specific patient group.
Main Methods:
- Analysis of 369 surgically treated acoustic neuroma patients.
- Inclusion criteria: strictly normal hearing (pure-tone average < 20 dB, speech discrimination > 90%, interaural differences ≤ 10 dB).
- Comparison of audiological tests and magnetic resonance imaging (MRI) sensitivity.
Main Results:
- Ten out of 369 patients (2.7%) had strictly normal hearing.
- High-level audiologic functioning significantly reduced auditory brainstem response (ABR) sensitivity.
- Magnetic resonance imaging demonstrated 100% sensitivity in detecting acoustic neuroma in these cases.
Conclusions:
- Acoustic neuroma should be suspected even with normal hearing and negative ABR.
- MRI is the most sensitive preoperative test for acoustic neuroma with normal hearing.
- Unexplained unilateral audiovestibular symptoms warrant high clinical suspicion regardless of hearing status.