Case Presentation Conference -Memorial- January 24, 2002

Case Presentation Conference -Memorial- January 24, 2002

Case Presentation Conference -MemorialJanuary 24, 2002 Jason Hunt M.D. Brian Kerr M.D. Peter Rigby M.D. Chief Complaint

65 y.o. female presents with complaint of decreased hearing in the left ear. Has worsened over several years now what? No hx of infection, trauma, previous ear

surgery. No pain. No significant noise exposure (works as librarian)., no family hx of hearing loss. No hx of ototoxic drugs. Complains of mild dysequilibrium tinnitus only on left (non-pulsatile)

Otolaryngology ROS

no wt loss no dysphagia, no odynophagia no hoarseness or change in voice no globus sensation no aspiration or sense of choking on food.

Med Hx: Hypertension, tx with HCTZ Surg Hx: none Meds: HCTZ

ROS: unremarkable, good exercise tolerance walks for 30 minutes every morning Physical Exam

Ears Nose Throat neuro

Physical Exam Vibrant, pleasant women Remarkable findings:

Ears: normal exam, oral: symm palate, +gag, tongue mobile no facial weakness, no facial parasthesia

TVC equally mobile, decreased corneal reflex left eye left + Hitzleberger sign. Other clinical testing? Forks

Weber lateralized to the right Rinne: right is + Rinne: left is + Imp/Plan: IMP/Plan ?

ABR vs. MRI Advantages/Disadvantages

E - Eighth nerve (wave I).2.0 msec C - cochlear nucleus (wave II).3.0 msec O - superior olive (wave III)4.1 msec L - lateral lemniscus (wave IV)..5.3 msec I - inferior colliculus (wave V)..5.9 msec

What about calorics? Treatment Options Treatment Options Observation

surgery (what approaches?) what about gamma knife? Surgery Retrosigmoid or suboccipital hearing conservation except lateral 1/3 of IAC need to retract on cerebellum/ post op H/A

Translabyrinthine most direct/ good exposure (including VII) does not conserve hearing Middle Fossa approach hearing conservation, exposes lateral 1/3 IAC

Anatomy Cerebellar Pontine Angle

medially roof Post. floor lateral surface of brainstem

cerebellum/middle cerebellar ped. Cerebellum/cerebellar tonsil arachnoid assoc. with lower nn.

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