Acute vestibulochochlear neuronitis and cochlear implantation
23 April 2019 (online)
Vestibulocochlear neuritis shows a sensineural deafness with vertigo. In addition with a facial palsy and an herpes zoster (HZV) infection it is described as Ramsay Hunt syndrome. The clinical evidence of the virus is often only possible post mortem by biopsy of the ganglion geniculi.
A 52-year-old woman presented with new onset otalgia, hearing loss and vertigo. The diagnosis of serous otitis media with inner ear involvement was made and treated with tympanic drainage, intravenous antibiotics and cortisone. Following up, a progression of the hearing loss to surdity was observed and radiologically a mastoiditis with osteolysis occured, so that a mastoidectomy was performed. One week postoperatively a facial palsy occured. MRI revealed incipient sclerosis of the cochlea and absorption of the nerves in the cerebellopontine angle.
A vasculitis or an infection with neurotropic viruses could not be detected serologically (also in the CSF). An antiviral therapy was initiated on a trial basis, during which the facial palsy was rapidly regressive. Because of the beginning sclerosis of the cochlea and the deafness, the patient was soon treated with a cochlear implant.
In the context of vestibulocochlear neuritis, hearing loss and vertigo are described. In addition, simultaneous facial palsy can occur. Despite the lack of evidence of infection with a neurotropic virus, the antiviral therapy may be useful. For radiologically progressive sclerosis of the cochlea, the timely implantation of a cochlear implant is recommended.