Clinical and Pathologic Aural Findings in a Case of Diffuse Metastatic Leptomeningeal Carcinomatosis

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The otological symptoms and temporal bone findings in a 56-year old female with deafness due to subarachnoid metastases of adenocarcinoma of the lung are described.Hearing in the left ear was almost totally lost in about 3 days, and after 18 days the right ear became involved. She denied vertigo except for some unsteadiness on walking. There was slight left facial weakness and left IX th & X th nerve paralysis and severe bilateral deafness. However, hearing in the right ear improved about 35 dB during treatment (60Co radiation and chemotherapy). The caloric response to ice water was absent in the left ear. The galvanic nystagmus test revealed that the site of damage was the left superior vestibular nerve and ganglion.She died about 15 months after the onset of otologic symptoms. The temporal bones were removed approximately four hours after death, fixed, and processed in the usual manner.The left ear: The internal auditory canal was not filled with tumor cells, but the VIII th nerve was severely degenerated. There was marked loss of cochlear neurons and severe degeneration of the superior vestibular nerve and ganglion. The organ of Corti and the sensory elements in all the vestibular organs appeared to be intact. There was slight partial degeneration of the facial nerve. The middle ear and mastoid were normal.The right ear: The internal auditory canal was free of tumor. Part of the VIII th nerve was still intact, but the cochlear neurons were decreased. The organ of Corti and the sensory & neural elements of vestibular end organs appeared intact.
耳鼻咽喉科臨床学会の論文

Clinical and Pathologic Aural Findings in a Case of Diffuse Metastatic Leptomeningeal Carcinomatosis

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