Auditory deficits and hearing loss associated with focal brainstem haemorrhage

Four cases of central pontine haemorrhage are described in which auditory dysfunction was documented. Two cases had a hearing loss, in one of which there was recovery of the low frequencies. This case provides support for the tonotopic organization of the auditory pathways in the caudal pontine area, with the lowest frequencies being encoded medially. In all cases, there were abnormalities of the auditory brainstem responses, wave V being consistently involved, while wave III was abnormal in only one patient. In three cases, the masking level differences and crossed acoustic reflex thresholds were abnormal. The ipsilateral reflex thresholds were normal at least on one side in all cases. In the patient with the most significant hearing loss, loudness recruitment, assessed both psychophysically and with the acoustic reflex thresholds, was evident. These data are interpreted in terms of there being damage to the medial superior olivary nuclei and trapezoid body involving both afferent and efferent fibres.