Ochoa CMF, Camargo VN, Montes OEJ, Ponce PJM, Cisneros LJC

Language: Spanish
References: 13
Page: 139-146
PDF size: 206.18 Kb.

ABSTRACT

Background: A sudden hearing loss is defined as an auditory loss greater than 30 decibels over at least three contiguous frequencies, within a 72-hour period. It has different aetiologies, although it is often considered idiopathic. The viral aetiology (caused by viruses of the Herpesviridae family) and the vascular are the most common. As part of the diagnostic process, a magnetic resonance is performed in all cases of sudden hearing loss to rule out retrocochlear disease. Currently, the use of systemic or intratympanic steroids during the first three weeks of onset is the basis of treatment.
Clinical case: A 57-year-old female patient with left ear sudden hearing loss with associated tinnitus, vertigo, and dizziness. On physical examination, she was found to have unilateral sensorineural hearing loss, determined by pure-tone audiometry, as well as a vertical, down-beating nystagmus observed during otoneurologic exploration. Magnetic resonance showed a significant herniation of the cerebellum tonsils through the foramen magnum (compatible with an Arnold-Chiari type I malformation). Systemic and intratympanic steroids were prescribed without success, so management aimed at rehabilitation and close monitoring.
Conclusions: Sudden hearing loss secondary to an Arnold-Chiari type 1 malformation is infrequent, especially as an isolated or initial symptom. The inferior extension of the magnetic resonance performed as part of the diagnostic algorithm of sudden hearing loss, to evaluate the cerebellum tonsils, may be an effective measure to rule out this condition in such patients.

REFERENCES

1. Chandrasekhar S, Tsai-Do B, Schwartz S, Bontempo L,Faucett E, Finestone S, et al. Clinical practice guideline:Sudden hearing loss (update). Otolaryngol Head Neck Surg 2019; 161 (IS): S1-S45. doi: 10.1177/0194599819859885.

2. Muñoz-Proto F, Carnevale C, Bejerano-Panadés N, Ferran L,Mas-Mercant S, Sarría-Echegaray P. Manejo de hipoacusianeurosensorial súbita en atención primaria. Semergen2014; 40 (3): 149-154.

3. Guerra-Jiménez G, Mazón-Gutiérrez A, Marco-de-LucasE, Valle-San-Román N, Martín-Laez R, Morales-Angulo C.Manifestaciones audiovestibulares en la malformaciónde Chiari tipo I. Serie de casos y revisión bibliográfica.Acta Otorrinolaringol Esp 2014; 66 (1): 28-35. https://doi.org/10.1016/j.otorri.2014.05.002.

4. Siegel L-G. The treatment of idiopathic sudden sensorineuralhearing loss. Otolaryngol Clin North Am 1975; 8 (2): 467-473. https://doi.org/10.1016/S0030-6665(20)32783-3.

5. Rydell R, Pulec J. Arnold-Chiari malformation. ArchOtolaryng 1974; 94 (1): 8-12. doi: 10.1001/archotol.1971.00770070044002.

6. Haktanir A, Yücedağ F, Kaçar E, Ulu S, Ali-Gültekin M,Bucak A. Association of Chiari I malformation andcerebellar ectopia with sensorineural hearing loss. JCraniofacial Surg 2013; 24 (4): 1153-1155. doi: 10.1097/SCS.0b013e318293f840.

7. Machado A, Dias J, Silva A, Meireles A. Chiari type 1malformation: An unusual cause of tinnitus. Int TinnitusJ 2023; 27 (1): 06-09.

8. Tubbs R, Turgut M, Oakes W. The Chiari malformations. 2aed. Suiza: Springer; 2020: 387-389.

9. Cantillano P, García K, Olmedo D, Délano R. Nistagmovertical hacia abajo. Rev Otorrinolaringol Cir Cabeza Cuello2019; 79 (3): 329-335. http://dx.doi.org/10.4067/S0718-48162019000300329.

10. Wagner J, Glaser M, Brandt T, Strupp M. Downbeat nystagmus:aetiology and comorbidity in 117 patients. J NeurolNeurosurg Psychiatry 2008; 79: 672-677. doi: 10.1136/jnnp.2007.126284.

11. Prashanth P, Anu-Sara A, Devika V, Annika-Mariam S,Shanthala S, Ramadevi S. Audio-vestibular findings in anadult with Arnold-Chiari malformation. J Hear Sci 2020;10 (4): 85-90. https://doi.org/10.17430/JHS.2020.10.4.8.

12. Sivakanthan S, Goldhagen C, Danner S, Agazzi S. Hearingloss and Chiari malformation: A clinical pearl. Clin NeurolNeurosurg 2014; 122: 20-22. https://doi.org/10.1016/j.clineuro.2014.04.007.

13. Johnson GD, Harbaugh RE, Lenz SB. Surgical decompressionof Chiari I malformation for isolated progressivesensorineural hearing loss. Am J Otol 1994; 15 (5): 634-638.