Midterm Case Studies

Question 1

Case Study

• 47-year-old female presents with a recent onset hearing loss
• Slight dizziness and unilateral tinnitus in the right ear since about two years – no vertigo reported
• Treated for back pain with Vicodin for ~ one year
• History of high blood pressure
• History of type 2 diabetes (poorly controlled) for 15 years
• No family/genetic history of hearing loss
• No history of noise exposure
• Physician referral for a hearing evaluation

Answer 1

Right Vestibular Schwannoma
Left ear
* normal
* Good absolute and interwave latency

Right ear
* normal wave 1 – inner ear normal
* wave three possibly 3.48 not clearly defined
* Interpeak latency is normal 1-3
* Absent 5 → retrocochlear pathology on the right side

Question 2

• 45-year-old female presents with a unilateral sudden onset hearing loss since about two days
• “Loud” unilateral tinnitus in the right ear since about two days – no dizziness reported
• Moderate occasional non-specific otalgia since a week
• No family/genetic history of hearing loss
• No history of noise exposure
• Physician referral for a hearing evaluation

Answer 2

Non - Organic/ Malinger
ABR and Audio do not align with that signifance of a HL wave 1 latecies would be progloed or absent

Normal ABR
* Left and right ear absolute latency are within normal limits
* Interwave peak latencies also normal
* Interaural within normal range
* Wave 1 is absent but this is normal @ contralaterals

Audiogram
* Unilateral HL
* Normal in the left ear
* Moderate to profound SNHL in the right ear

Question 3

• 18-year-old male referred with history of consistently failing school hearing screenings but no history of amplification
• At age 13, pure-tone audiometry indicated a bilateral mild to moderate SNHL that progressed to a moderately severe to severe SNHL over the next several years with difficult to describe configuration
• History of developmental delays, referred to as “clumsy”
• Reported difficulty following directions in the classroom especially in noise
• Poor academic performance; labeled as “inattentive”
• Reported history of balance problems - disequilibrium
• Family history of hearing loss

Answer 3

Charcot-Marie-Tooth syndrome and associated ANSD

ABR
* Abnormal, no identifiable waveforms
* Poor morphology (poor synchrony)
* Reversal of waveform with change in polarity