Minimal Hearing Loss Leading to the Diagnosis of Temporal Lobe Tumor
Background: Brain tumors, even large ones, may present with minimal ENT symptoms including minimal hearing loss.
Aim: The presentation of a case of temporal lobe tumor that had an almost normal audiogram with 25 dB hearing loss in 8000 Hz.
Material and Methods: A 32-year-old man had a vague impression of fullness in the right ear that lasted a few days and settled afterwards. The only constant symptom was a gradual loss in speech discrimination and the patient's preference to use the telephone in the right ear. The patient had an almost normal audiogram with 25 dB hearing loss only at 8000 Hz in the left ear. The ABR showed a wave V delay of 0.4 ms at the right side.
Results: The MRI scan revealed a 3.6-cm tumor in the right temporal lobe that was not enhanced with intravenous contrast. His neurological examination was normal. The patient was operated and his histology showed a grade II oligodendroglioma. Three months later his audiogram returned to normal with a considerable improvement of the speech discrimination. ABR returned to normal.
Conclusions: Hearing loss due to brain lesions more central than the brainstem is challenging not only to neurologists and neurosurgeons but also to otolaryngologists as they may be the primary physicians involved. ENT surgeons should be aware that central lesions even of a considerable size may cause only minimal auditory symptoms. Otherwise underdiagnosis may result in substantial delay affecting management and prognosis.