GTA 304

AUDIOLOGY CLINIC II
CASE PRESENTATION
TAN LEE XUAN
117385

PATIENTS PROFILE
Patients Initial
: MF
RN
: B075290
Date of Birth
: 06-10-1990
Age
: 25 years old
Gender
: Male
Race
: Malay
Referred from
: ORL Clinic
Date of Clerking
: 19-03-2015

PATIENTS HISTORY

A history of nasal hemangiopericytoma

Surgery was done in 2003 and
Defaulted follow-up on radiotherapy since 2004
1st phase was done
2nd phase was postponed due to facial trauma
resulting from a Motor Vehicle Accident on 23-082004
Right cheek swelling & lateral subconjunctival
hemorrhage

Tinnitus onset about 15 years ago on left ear

PRESENT SITUATION
New case
Referred from ORL clinic for hearing assessment
Patient claimed that the hearing level get worse in
both ears & does not improved after the surgery
Tinnitus bilaterally
left ear is about 15 years ago
right ear is just developed recently
louder in the left ear
sound like sea waves
patient is already get used to it

PRESENT SITUATION
Has problem in listening in noisy environment
No otalgia, no otorrhea, no noise exposure and no
family history of hearing loss were reported

PREVIOUS ASSESSMENT (2014)

ORL
Pure Tone Audiometry result
Mild to moderate mixed hearing loss in the
right ear
Moderate to profound sensorineural hearing
loss in the left ear

15-01-2014
X
X
X

PREVIOUS ASSESSMENT (2011)

ORL
Pure Tone Audiometry result
Moderate to severe sensorineural hearing
loss in the right ear
Severe to profound mixed hearing loss in
the left ear

2011

>
]

>

>
]

>

]
X

]
X

>
]
X

PREVIOUS ASSESSMENT (2012)

ORL
Pure Tone Audiometry result
Moderate to profound sensorineural hearing
loss in the right ear
Severe to profound sensorineural hearing
loss in the left ear

2012

>
]

>
]

>

>

>
X

X
X

LATEST AUDIOLOGICAL FINDINGS

(06-11-2014)
Otoscopic Examination
Partially occluded external auditory canal
with wax and intact tympanic membrane in
the right ear
Clear external auditory canal with minimal
wax, tympanic membrane could not be
visualised in the left ear

AUDIOLOGICAL FINDINGS
Pure Tone Audiometry result
Profound sensorineural hearing loss in the
left ear
Moderate to profound mixed hearing loss in
the right ear

<

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>

< >

]
]

<

>
] <
X

X
X

* Not Enough
Masking
Reliability :
Good

AUDIOLOGICAL FINDINGS
Tympanometry results
type A tympanograms in both ears are
suggestive of normal middle ear
pressure in both ears.
Ear

Type

Comp (ml)
0.40

Peak (da
Pa)
-3

Eq. Vol
(ml)
1.46

Right

Left

0.43

-27

2.04

AUDIOLOGICAL FINDINGS
Acoustic Reflex
Absent acoustic reflex in left ipsilateral, left
and right contralateral pathway
Probe

Tone

500Hz

1000Hz

2000Hz

RE

LE

105

105

105

LE

RE

105

105

105

RE

RE

LE

LE

105

105

105

MANAGEMENT
Explain result to patient
Make appointment with ENT doctors for
medical clearance
To come again on 08-01-2014 after
appointment with ENT doctors

DISCUSSION
Hemangiopericytoma
Hemangiopericytoma is a rare vascular
tumour occurring anywhere in the body, but
more commonly involves the soft tissues of
trunk and lower extremities.
Approximately 15% of all soft tissue HPCs
occur in the head and neck region, mainly in
the nasal cavity and paranasal sinuses.
(Kamath et al, 2013)

DISCUSSION

DISCUSSION

DISCUSSION
Hemangiopericytomas of the nasal cavity and
paranasal sinuses exhibit low malignant
potential and distant metastasis. (Kamath et al, 2013)

DISCUSSION
Radiotherapy
The radiotherapy has been proved to be the most
valuable modality in the cancer management in head
and neck cancer patients.
The radiation induced hearing loss has long been
recognized as an important side effect in the
management of head and neck neoplasm.
Due to the close proximity of the tumour, the normal
neighbouring organs also especially the ear receive a
significant radiation dose. (Singh et al, 2014)

DISCUSSION
The side effects of radiotherapy on normal tissues of
head and neck are relatively common and
unavoidable, which depend on the site of radiation,
total dose delivered and daily fraction of radiation
used.
The radiotherapy used in management of head and
neck tumours often includes the temporal bone and
brain stem.
The middle ear, inner ear and brain stem may receive
a significant radiation dose. (Singh et al, 2014)

DISCUSSION
A study by Schultz et al (2010)
282 individuals including
141 who had undergone radiation therapy for head and neck
tumors and
141 controls who had never undergone a treatment that placed
their hearing at risk.

Hearing loss was mostly sensorineural

Severe or profound hearing loss occurred more in the radiationtreated group
Participants in the radiation treatment group were more likely to
be severely impaired by hearing loss

DISCUSSION
Hearing loss is a common complication of radiation
treatment, which may be conductive, sensorineural
and mixed.
The inner ear is an organ at risk for patients
receiving irradiation in the head and neck area.
(Honore et al, 2002)

Dose of the radiation is proportional to development

of ototoxicity.

REFERENCES
Kamath, P. M., Shenoy, S.V., Nirupama, M. & Raj, T. V. (2013). Hemangiopericytoma: A rare sinonasal
tumor. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. Retrieved November 20, 2014
fromhttp://ac.els-cdn.com/S2090074013000273/1-s2.0-S2090074013000273-main.pdf?_tid=3f8f01e67313-11e4-b67e-00000aacb361&acdnat=1416748903_390227c51fc4abda8cb7cdfb8112a8b0
Singh, J., Jaiwardhan, G., Yadav, S., Gulia, J. & Bhisnoi, S. (2014). Effect of Radiotherapy on Hearing
Thresholds in Patients of Head and Neck Malignancies. The Internet Journal of Otorhinolaryngology.
Henriette B. Honore a,*, Sren M. Bentzenb, Kitty Mllerc, Cai Graud. (2002). Sensori-neural hearing
loss after radiotherapy for nasopharyngeal carcinoma: individualized risk estimation. Radiotherapy
and Oncology
Bhandare N1, Antonelli PJ, Morris CG, Malayapa RS, Mendenhall WM. (2007) Ototoxicity after
radiotherapy for head and neck tumors. Retrieved November 20, 2014 from
http://www.ncbi.nlm.nih.gov/pubmed/17236969
Schultz, C. (2010). Hearing loss common following radiation therapy for head and neck cancer.
Retrieved November 20, 2014 from http://phys.org/news/2010-11-loss-common-therapy-neckcancer.html#jCp