Content area
Full Text
(ProQuest: ... denotes non-US-ASCII text omitted.)
Clinical Records
Introduction
The nervus intermedius is a branch of the facial nerve with both parasympathetic and sensory components. Wrisberg named it after its intermediate location between the motor component of the facial nerve and the superior vestibular nerve. The nervus intermedius is rarely clinically significant. Nervus intermedius neuralgia is characterised by severe pain deep in the ear that may spread to the ear canal, outer ear, mastoid or eye regions. Hitselberger's sign is anaesthesia of the concha bowl and posterior external auditory canal resulting from a space-occupying lesion of the cerebellopontine angle that causes compression of the nervus intermedius.1
Tumour of the nervus intermedius is also quite rare. Because of its location, this tumour involves the internal auditory canal and is therefore often incorrectly diagnosed as vestibular schwannoma. Meningioma of the nervus intermedius has not been described. We performed a literature search with PubMed using the following keywords: nervus intermedius, nervus intermedius meningioma, cerebellopontine angle tumour and internal auditory canal tumour. The following case describes the clinical presentation, audiological and imaging findings, and the intra-operative and post-operative course of a patient with nervus intermedius meningioma.
Case report
A 48-year-old male presented to our clinic with a 5-year history of progressive right-sided hearing loss. He had developed associated dizziness and unilateral tinnitus a few years after first noting the hearing loss. His dizziness had increased in frequency and now occurred daily, with episodes lasting 2-3 hours each. There had not been any otalgia or otorrhoea. Eardrum, tuning fork, and cranial nerve test results were normal; there was no facial twitching or droop.
The pure tone average for the right ear was 58 dB compared with 10 dB for the left (Figure 1). Magnetic resonance imaging (MRI) showed a 2 mm enhancing mass impacted in the right fundus superiorly (Figures 2 and 3).
Fig. 1
Pre-operative audiogram for the (a) right and (b) left ears, showing flat, moderate, right sensorineural hearing loss. [Delta] = right ear air unmasked; [=right ear bone unmasked; × = left ear air unmasked; >= left ear bone unmasked
Fig. 2
Focused axial magnetic resonance image of the right internal auditory canal, showing an enhancing lesion laterally at the fundus which appears to arise from...