PANCE Blueprint EENT (9%)

Acoustic neuroma

Patient will present with → slowly progressive unilateral hearing loss, tinnitus, headache, facial numbness, continuous disequilibrium

Acoustic neuroma is a benign tumor of the schwann cells (the cells which produce myelin sheath) – most commonly affect the vestibular division of the 8'th cranial nerve.

  • Patient will present an ith insidious unilateral hearing loss, tinnitus, headache, facial numbness, continuous disequilibrium.
  • Unilateral hearing loss +/- Vertigo 

Definitive diagnosis is by MRI (Gold standard)

  • An audiogram is the first test done during a physical examination to diagnose acoustic neuroma. It usually reveals an asymmetric sensorineural hearing loss and a greater impairment of speech discrimination than would be expected for the degree of hearing loss.
  • Such findings indicate the need for imaging tests, preferably gadolinium-enhanced MRI.

Small or non-growing tumors can be observed with serial MRI scans

  • Stereotactic radiation therapy tends to be used for patients who are elderly, those with smaller tumors, or those who cannot undergo surgery for medical reasons.
  • Microsurgery can involve a hearing-preservation approach (middle cranial fossa or retrosigmoid approach) or a translabyrinthine approach if there is no useful residual hearing.

acoustic neuroma

Question 1
A 52-year-old male presents with unilateral left-sided hearing loss that has progressed over 2 months. His wife states that he has difficulty discriminating words, although he can hear the sounds. He has also experienced some imbalance lately, but he contributes this to trying to do too many things too quickly. Which of the following is the likely pattern of testing on physical exam?  
A
Rinne air conduction greater than bone conduction; Weber lateralizes to left.
Hint:
See B for explanation
B
Rinne air conduction greater than bone conduction; Weber lateralizes to right.
C
Rinne bone conduction greater than air conduction; Weber lateralizes to right.
Hint:
In conductive hearing loss, the Rinne will result in bone conduction greater than air conduction and Weber will lateralize ipsilaterally.
D
Rinne bone conduction greater than air conduction; Weber lateralizes to left.
Hint:
In conductive hearing loss, the Rinne will result in bone conduction greater than air conduction and Weber will lateralize ipsilaterally.
Question 1 Explanation: 
This patient likely has an acoustic neuroma. Sensorineural hearing loss will result in air conduction greater than bone conduction and contralateral Weber
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