Introduction:
Vestibulocochlear neuritis shows a sensineural deafness with vertigo. In addition
with a facial palsy and an herpes zoster (HZV) infection it is described as Ramsay
Hunt syndrome. The clinical evidence of the virus is often only possible post mortem
by biopsy of the ganglion geniculi.
Case:
A 52-year-old woman presented with new onset otalgia, hearing loss and vertigo. The
diagnosis of serous otitis media with inner ear involvement was made and treated with
tympanic drainage, intravenous antibiotics and cortisone. Following up, a progression
of the hearing loss to surdity was observed and radiologically a mastoiditis with
osteolysis occured, so that a mastoidectomy was performed. One week postoperatively
a facial palsy occured. MRI revealed incipient sclerosis of the cochlea and absorption
of the nerves in the cerebellopontine angle.
Result:
A vasculitis or an infection with neurotropic viruses could not be detected serologically
(also in the CSF). An antiviral therapy was initiated on a trial basis, during which
the facial palsy was rapidly regressive. Because of the beginning sclerosis of the
cochlea and the deafness, the patient was soon treated with a cochlear implant.
Conclusion:
In the context of vestibulocochlear neuritis, hearing loss and vertigo are described.
In addition, simultaneous facial palsy can occur. Despite the lack of evidence of
infection with a neurotropic virus, the antiviral therapy may be useful. For radiologically
progressive sclerosis of the cochlea, the timely implantation of a cochlear implant
is recommended.
