Unilateral asymmetric hearing loss with imbalance
7 stems
What is your differential diagnosis and what feature of her audiogram most concerns you?
Which investigation is definitive, and what would you expect to see?
The MRI confirms an 18 mm left vestibular schwannoma at the cerebellopontine angle. How would you classify it, and what are the management options?
She elects for surveillance. On her second scan the tumour has grown by 3 mm. She now wishes to consider treatment. Her word recognition remains 48%. Which treatment would you recommend and why?
She chooses translabyrinthine surgery. Consent her for the operation.
On day three she develops clear rhinorrhoea and headache. What is your approach?
What long-term follow-up is required?
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