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Sudden Bilateral Profound Hearing Loss Resulting from Meningeal Carcinomatosis

SBPHL is a rare manifestation of hearing loss. Patients with SBPHL should have a thorough evaluation for meningeal carcinomatosis as the cause, including a complete neurologic evaluation, CT scan, and, probably, MRI. If MC is highly suspected, an LP is necessary. Because the diagnosis of MC can be confirmed only by the presence of malignant cells in the CSF, multiple LPs may be necessary to find them. Although MC should be strongly considered in the differential diagnosis of SBPHL, MC should also be considered with other patterns of eighth cranial nerve involvement, especially in patients with a history of malignancy. These patterns include unilateral hearing loss associated with tinnitus, unilateral hearing loss rapidly progressing to severe bilateral involvement, audiologic and caloric studies that show eighth cranial nerve impairment, and facial nerve palsy associated with hearing loss. The prognosis for MC is poor, although intraventricular chemotherapy and whole brain radiotherapy can provide significant palliation.