Jacobson J, Reams C
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center, Houston 77030.
Am J Otol. 1991 Mar;12(2):114-8.
Clinical suspicion remains an underlying diagnostic clue in the evaluation of patients with unconfirmed acoustic neuromas. This is particularly true when initial otologic and audiologic evaluations are equivocal. This paper summarizes a series of four patients each who demonstrated normal audiometric (pure-tone and conventional speech audiometry) and/or ABR findings in the presence of surgically confirmed intracanalicular or cerebellopontine angle tumors. Three of the patients presented with evidence of "classical" acoustic tumors, whereas the fourth patient revealed a benign internal auditory canal capillary hemangioma. Audiologic evaluation, ABR measures, and MRI scanning demonstrate the relationships observed in each of the four patients. Diagnostic strategies illustrate the importance of cross-check principles (audiologic, electrophysiologic, and imaging techniques) in the diagnosis of posterior fossa tumors. The presence of normal pure-tone thresholds should not discourage the pursuit of additional diagnostic measures if clinical suspicion remains a factor in comprehensive patient management.
在未确诊的听神经瘤患者评估中，临床怀疑仍然是一项潜在的诊断线索。当最初的耳科和听力学评估不明确时，情况尤其如此。本文总结了一系列各有四名患者的病例，这些患者在经手术证实存在内耳道或桥小脑角肿瘤的情况下，听力测验（纯音和传统言语测听）和/或听性脑干反应（ABR）结果均正常。其中三名患者表现出“典型”听神经瘤的证据，而第四名患者显示为良性内耳道毛细血管瘤。听力学评估、ABR测量和磁共振成像扫描展示了在这四名患者中观察到的关系。诊断策略说明了交叉核对原则（听力学、电生理和成像技术）在颅后窝肿瘤诊断中的重要性。如果临床怀疑仍然是综合患者管理中的一个因素，纯音阈值正常的情况不应阻碍采取额外的诊断措施。
