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Contralateral hearing loss and facial palsy in an operated case of vestibular schwannoma-Case report.
Int J Surg Case Rep 2016; 29:47-50IJ

Abstract

INTRODUCTION

Contralateral ear hearing loss (CHL) is an extremely rare but a potentially devastating complication in a patient with already compromised hearing due to a Vestibular schwannoma (VS). Our patient had CHL accompanied by contralateral facial palsy. Our case is only the second case reported in literature to the best of our knowledge.

PRESENTATION OF CASE

A 55-year elderly male presented with right sided sensorineural hearing loss, cerebellar signs and Grade II House & Brackmann (H&B) facial nerve weakness for last1-year. Magnetic resonance imaging (MRI) scan revealed a large right sided vestibular schwannoma (VS) with severe compression of the ipsilateral pons. The pre-operative pure tone audiometry (PTA) documented severe sensory neural hearing loss (SNHL) on the right side along with mild SNHL on the left side. A right retromastoid suboccipital craniotomy was performed and VS was completely excised. The ipsilateral facial nerve was preserved anatomically. On the 4th post-operative day he developed severe pain and tinnitus in left ear. In the next 24-h there were hearing loss and grade II facial nerve paresis. The PTA done on the 5th post-operative day revealed severe SNHL on both sides. He was managed conservatively with steroids and vasodilators. At 6-months of follow-up the left side hearing loss and facial weakness had significantly recovered. The PTA showed significant improvement in the left side SNHL DISCUSSION: Contralateral hearing disturbance with contralateral facial palsy after acoustic neuroma surgery is extremely rare. The exact etiopathogenesis of this unusual phenomenon is not clear and various theories have been proposed. There is no standard recommendation for treatment of these rare complications and the etiology remains obscure.

CONCLUSION

Hearing loss and facial palsy on the contralateral side after VS surgery is extremely rare. It is imperative that this rare complication should be considered following VS surgery.

Authors+Show Affiliations

Department of Neurosurgery, P.D. Hinduja National Hospital & MRC, Mahim, Mumbai 400016, India. Electronic address: abhi.w82@gmail.com.Department of Neurosurgery, P.D. Hinduja National Hospital & MRC, Mahim, Mumbai 400016, India. Electronic address: ficus_pwn@yahoo.co.in.Department of Neurosurgery, P.D. Hinduja National Hospital & MRC, Mahim, Mumbai 400016, India. Electronic address: dranshuwarade@gmail.com.Department of Neurosurgery, P.D. Hinduja National Hospital & MRC, Mahim, Mumbai 16, India. Electronic address: drketandesai@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27815992

Citation

Warade, Abhijit, et al. "Contralateral Hearing Loss and Facial Palsy in an Operated Case of Vestibular schwannoma-Case Report." International Journal of Surgery Case Reports, vol. 29, 2016, pp. 47-50.
Warade A, Chawla P, Warade A, et al. Contralateral hearing loss and facial palsy in an operated case of vestibular schwannoma-Case report. Int J Surg Case Rep. 2016;29:47-50.
Warade, A., Chawla, P., Warade, A., & Desai, K. (2016). Contralateral hearing loss and facial palsy in an operated case of vestibular schwannoma-Case report. International Journal of Surgery Case Reports, 29, pp. 47-50. doi:10.1016/j.ijscr.2016.10.032.
Warade A, et al. Contralateral Hearing Loss and Facial Palsy in an Operated Case of Vestibular schwannoma-Case Report. Int J Surg Case Rep. 2016;29:47-50. PubMed PMID: 27815992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contralateral hearing loss and facial palsy in an operated case of vestibular schwannoma-Case report. AU - Warade,Abhijit, AU - Chawla,Pawan, AU - Warade,Anshu, AU - Desai,Ketan, Y1 - 2016/10/17/ PY - 2016/09/16/received PY - 2016/10/07/revised PY - 2016/10/11/accepted PY - 2016/11/7/pubmed PY - 2016/11/7/medline PY - 2016/11/6/entrez KW - Case report KW - Contralateral ear hearing loss KW - Contralateral facial palsy KW - Post-operative KW - Vestibular schwannoma SP - 47 EP - 50 JF - International journal of surgery case reports JO - Int J Surg Case Rep VL - 29 N2 - INTRODUCTION: Contralateral ear hearing loss (CHL) is an extremely rare but a potentially devastating complication in a patient with already compromised hearing due to a Vestibular schwannoma (VS). Our patient had CHL accompanied by contralateral facial palsy. Our case is only the second case reported in literature to the best of our knowledge. PRESENTATION OF CASE: A 55-year elderly male presented with right sided sensorineural hearing loss, cerebellar signs and Grade II House & Brackmann (H&B) facial nerve weakness for last1-year. Magnetic resonance imaging (MRI) scan revealed a large right sided vestibular schwannoma (VS) with severe compression of the ipsilateral pons. The pre-operative pure tone audiometry (PTA) documented severe sensory neural hearing loss (SNHL) on the right side along with mild SNHL on the left side. A right retromastoid suboccipital craniotomy was performed and VS was completely excised. The ipsilateral facial nerve was preserved anatomically. On the 4th post-operative day he developed severe pain and tinnitus in left ear. In the next 24-h there were hearing loss and grade II facial nerve paresis. The PTA done on the 5th post-operative day revealed severe SNHL on both sides. He was managed conservatively with steroids and vasodilators. At 6-months of follow-up the left side hearing loss and facial weakness had significantly recovered. The PTA showed significant improvement in the left side SNHL DISCUSSION: Contralateral hearing disturbance with contralateral facial palsy after acoustic neuroma surgery is extremely rare. The exact etiopathogenesis of this unusual phenomenon is not clear and various theories have been proposed. There is no standard recommendation for treatment of these rare complications and the etiology remains obscure. CONCLUSION: Hearing loss and facial palsy on the contralateral side after VS surgery is extremely rare. It is imperative that this rare complication should be considered following VS surgery. SN - 2210-2612 UR - https://www.unboundmedicine.com/medline/citation/27815992/Contralateral_hearing_loss_and_facial_palsy_in_an_operated_case_of_vestibular_schwannoma_Case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(16)30429-1 DB - PRIME DP - Unbound Medicine ER -