S.R., a 55-year-old man, was seen with the complaint of decreased hearing sensitivity in his left ear for the past 3 years. In addition to hearing loss, he was experiencing tinnitus and aural fullness. Pure tone test results revealed normal hearing sensitivity for the right ear and a moderate sensorineural hearing loss in the left ear. Speech thresholds were appropriate for the degree of hearing loss noted. Word recognition was excellent for the right ear and poor for the left ear when the signal was present at a suprathreshold level. Tympanograms were characterized by normal shape, amplitude, and peak pressure points bilaterally. The contralateral acoustic reflex was normal for the right ear but absent for the left ear at the frequencies tested (500 to 4000 Hz). The ipsilateral acoustic reflex was present with the probe in the right ear and absent with the probe in the left ear. Brainstem auditory evoked potentials (BAEP) were within normal range for the right ear. No repeatable response was observed from the left ear. A subsequent MRI showed a 1-cm acoustic neuroma.
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