Unilateral hearing loss as a presenting manifestation of granulocytic sarcoma (chloroma)

Objective: To present a case of acute granulocytic sarcoma of the cerebellopontine angle whose presenting symptom was sudden onset unilateral sensorineural hearing loss. Study Design: Case report and review of the literature (MEDLINE, 1962-2005). Methods: A 34-year-old female patient with acute myeloid leukemia on remission admitted because of sudden hearing loss in her right ear for 10 days. She had experienced occasional tinnitus, ear fullness, and dizziness for a couple of months. After confirmation of her audiometric findings with auditory brainstem responses, the patient was put on a treatment regimen for sudden hearing loss. Results: On the second day of treatment, she developed ipsilateral facial paralysis, hoarseness caused by ipsilateral vocal fold paralysis, and nystagmus. Magnetic resonance imaging of the cranium revealed findings consistent with granulocytic sarcoma at the cerebellopontine angle, infiltrating the internal acoustic canal. As increased intracranial pressure symptoms developed subsequently, subtotal tumor resection was performed. However, the patient was lost, with Cushing's triad at the second postoperative month during postoperative chemotherapy. Conclusion: Although up to 40% of leukemic patients may have otologic symptoms, sudden onset of sensorineural hearing loss is very rare. The patient presented in this report is the first reported case with a granulocytic sarcoma of the cerebellopontine angle who presented with acute sensorineural hearing loss. Despite the rarity of such a case, we would like to emphasize that leukemia must be kept in mind as an etiologic factor in sensorineural hearing loss and suggest that complete blood count and temporal bone imaging be routinely obtained.