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Case Presentation Conference -Memorial- January 24, 2002

Case Presentation Conference -Memorial- January 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?.

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Case Presentation Conference -Memorial- January 24, 2002

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  1. Case Presentation Conference-Memorial-January 24, 2002 Jason Hunt M.D. Brian Kerr M.D. Peter Rigby M.D.

  2. Chief Complaint • 65 y.o. female presents with complaint of decreased hearing in the left ear. • Has worsened over several years • now what?

  3. 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)

  4. 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.

  5. Med Hx: Hypertension, tx with HCTZ • Surg Hx: none • Meds: HCTZ • ROS: unremarkable, • good exercise tolerance walks for 30 minutes every morning

  6. Physical Exam • Ears • Nose • Throat • neuro

  7. 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?

  8. Forks • Weber lateralized to the right • Rinne: right is + • Rinne: left is +

  9. Imp/Plan:

  10. IMP/Plan ?

  11. 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

  12. What about calorics?

  13. Treatment Options

  14. Treatment Options • Observation • surgery (what approaches?) • what about gamma knife?

  15. 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

  16. Anatomy • Cerebellar Pontine Angle • medially lateral surface of brainstem • roof cerebellum/middle cerebellar ped. • Post. Cerebellum/cerebellar tonsil • floor arachnoid assoc. with lower nn.

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