(Kiosk 3) Sudden Deafness After Partial Pontine Stroke

Case Diagnosis: 54-year-old male with right cerebellar and right brachium pontis infarction.

Case Description: A 54-year-old male with a past medical history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to the hospital with dysarthria, deafness, facial droop and difficulty walking. Neurological evaluation revealed right cerebellar and right brachium pontis infarction.
The patient was transferred to an acute inpatient rehabilitation unit with severe right facial droop, loss of sensation over the right side of the face, loss of hearing in the right ear, dysphagia, in addition to gait ataxia and dysmetria.
Rehabilitation consisted of physical therapy (PT), occupation therapy (OT), and speech-language therapy (SLT). PT addressed strength and gait training with proper balance. OT focused on selfcare, activities of daily living, and fine motor coordination. SLT targeted speech intelligibility and swallowing with the use of vital stimulation and motor exercises.

Discussion: Deafness is usually due to infarction of the cochlear nucleus or auditory nerve that lies in the lower medulla. Brainstem auditory evoked potentials (BAEPs) are neurophysiological tests used to assess the auditory pathway from the ear to the brainstem. In this case, BAEPs could assist in identifying the site of the lesion causing the hearing loss. The long-term improvement of hearing is variable with peak improvement between 10 to 12 months after the stroke.

Setting: The patient performed therapy in an acute inpatient rehabilitation unit.

Assessment/Results: After 2 weeks of intense therapy, the patient returned home with much improved functional outcome.

Conclusion: Sudden deafness due to brainstem infarct could be underdiagnosed if it is not accompanied with other neurological changes such as face drooping or dysarthria.