Chronic pachymeningitis presenting as asymmetric sensorineural hearing loss.
OBJECTIVE
The objective of this study was to characterize the auditory dysfunction associated with chronic pachymeningitis (inflammation of the dura mater).


METHODS
We conducted a university-based retrospective review.


RESULTS
Three patients were identified who were diagnosed with chronic pachymeningitis after being referred for asymmetric sensorineural hearing loss. All patients were found to have other neurologic symptoms and signs during careful neurotologic evaluation. Two varieties of chronic pachymeningitis exist: a hypertrophic mass lesion and a linear dural thickening. Although the hypertrophic variety could be easily detectable by noncontrast magnetic resonance imaging (MRI), the linear form is only visible with the use of gadolinium enhancement.


CONCLUSIONS
Chronic pachymeningitis is a rare form of sensorineural hearing loss that could portend an underlying disease of greater concern. Extensive evaluation is needed to exclude identifiable causes of chronic pachymeningitis, including infectious, neoplastic, and autoimmune diseases.


CONCLUSIONS
The clinician should be aware that the evaluation of a patient with asymmetric sensorineural hearing loss involves more than simply ruling out an acoustic neuroma. Fast-spin echo MRI techniques without the use of gadolinium contrast could miss a number of potentially treatable diseases such as chronic pachymeningitis. Patients with asymmetric sensorineural hearing loss should be carefully evaluated for other neurologic findings, and imaging with enhanced MRI is recommended.
Oghalai
John S
JS
The Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA. jso@bcm.tmc.edu
Ramirez
Alexander L
AL
Hegarty
Joseph L
JL
Jackler
Robert K
RK
D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D012189:Retrospective Studies