The facial schwannoma – a rare differential diagnosis of tinnitus

Introduction:

Tinnitus is a very common disease. The spectrum of appearances is as variable as that of the differential diagnoses to be considered.

Case report:

A 43-year-old female patient presented herself for the first time in our clinic with an exacerbation of her tinnitus on the right ear, which had been existing for three years. Initially, the patient described her unilateral ear noise as a tone. The increase and change into a noise and a pulsation led her to a ENT medical presentation again. The patient reported no further symptoms in the ENT area (in particular no hearing loss, no vertigo, no facial paralysis). For further diagnostic evaluation a pure tone audiogram and an MRI of the skull were performed natively and with contrast agent.

Results:

The ENT examination revealed normal ear canals and bland eardrums on both sides. The further ENT status was unremarkable. In pure tone audiogram normacusis was confirmed on both ears. The tympanometry also gave a normal result. In the cMRT a pronounced contrast affinity was present, most likely from the anterior genus of the right facial nerve, compatible with a schwannoma with expansive growth into the medial right fossa and displacement of the right temporal lobe. The transversal dimension of the tumor was 32 mm and the craniocaudal dimension was 28 mm.

Conclusion:

Schwannomas of VII. cerebral nerve are very rare. The tumor is often symptom-poor and, as in the presented case, it can be manifested only by the occurrence of tinnitus. This shows that the subtle differential diagnosis of tinnitus is always of outstanding importance.

Publication History

Publication Date:
23 April 2019 (online)