Sudden deafness and facial palsy from metastatic bronchogenic carcinoma

A 52-year-old man developed sudden total bilateral deafness, and unilateral facial palsy, without other symptoms and findings. He died two months later of of bronchogenic carcinoma metastatic to dura, brainstem, pons, carebellopontine angle, cerebellum and cranial nerves III, VI, VII and VIII. There was bilateral internal auditory canal erosion. Tumour replaced right facial, acoustic and vestibular nerves. Tumour infiltrated spiral ganglion, cochlear nerve, cochlear aqueduct, and destroyed nearly all facial nerve fibres to the level of the stapedius muscle. No tumour cells were found on the left, but few fibres of facial, acoustic and vestibular nerves survived. Both ears showed some cochlear outer hair cell destruction. Metastatic tumour to temporal bone or dura should be considered when loss of peripheral VIIth or VIIIth nerve function occurs.