Thomsen J, Terkildsen K, Tos M
Am J Otol. 1983 Jul;5(1):20-33.
The results obtained by conventional otologic evaluation are reported for fifty-nine patients with acoustic neuromas, sixty-one patients primarily suspected of an acoustic neuroma but in whom Pantopaque cisternography had invalidated the diagnosis, and in seventy-one patients with Meniere's disease. The audiologic tests were confined to the following: pure-tone audiometry, speech audiometry, recruitment examination by ABLB and Metz recruitment tests, and examination for reflex decay a.m. Anderson. Nineteen patients had an audiogram taken at their initial visit with the otologist, and already at this examination--4.2 years before the diagnosis was made--a high-tone hearing impairment was present. Fourteen patients had anacusis in the tumor ear and one patient had an impairment of 90 dB. The audiologic evaluations are based only on patients with hearing equal to or better than 80 dB. There was no connection between preoperative hearing impairment and the age at operation, and anacusis was found in all age groups. Four patients had recruitment by the ABLB test and six patients by the Metz recruitment test. When these two tests were combined, two patients had recruitment by both tests. Twenty percent had pathologic stapedial reflex decay. Only one patient had a normal differential caloric test. It is concluded that the typical patient with an acoustic neuroma has a gradually increasing unilateral hearing impairment of eight years' duration. A pronounced high-tone impairment with PTA of 55 dB and a poor discrimination score are to be expected. The patient is uncertain at pure-tone threshold determination and displays a lack of recruitment at both ABLB and Metz recruitment tests. The patient has a decreased or nonexistent differential caloric reaction in the ear in question. A normal differential caloric test does in all probability exclude an acoustic neuroma; however, all possible audiometric and anamnestic configurations may be encountered, and deviation from the "typical" picture should not lure the investigator into excluding the presence of a neuroma.
报告了59例听神经瘤患者、61例最初疑似听神经瘤但经碘苯酯脑池造影排除诊断的患者以及71例梅尼埃病患者的常规耳科评估结果。听力测试仅限于以下项目：纯音听力测定、言语听力测定、ABLB和梅茨重振试验的重振检查以及安德森反射衰减检查。19例患者在初次就诊于耳科医生时进行了听力图检查，在此次检查时（确诊前4.2年）即已出现高音听力损害。14例患者患侧耳全聋，1例患者听力损害达90分贝。听力评估仅基于听力等于或优于80分贝的患者。术前听力损害与手术年龄之间无关联，各年龄组均发现有全聋患者。4例患者经ABLB试验出现重振，6例患者经梅茨重振试验出现重振。当这两项试验联合进行时，2例患者两项试验均出现重振。20%的患者镫骨肌反射病理性衰减。仅1例患者冷热试验正常。结论是，典型的听神经瘤患者有持续8年的逐渐加重的单侧听力损害。预计会出现PTA为55分贝的明显高音损害和较差的辨别分数。患者在纯音阈值测定时不确定，在ABLB和梅茨重振试验中均无重振表现。患侧耳冷热反应减弱或消失。冷热试验正常很可能排除听神经瘤；然而，可能会遇到所有可能的听力测定和既往史情况，偏离“典型”表现不应诱使研究者排除神经瘤的存在。
