Are You Listening With The Other Ear?

By Dr. W. Gifford Jones

March 20, 1994

Á What should you do if the ear you normally use for the telephone isn't up to par anymore? That in order to hear adequately it's necessary to hold the telephone to the other ear? If so should you accept this as an aging problem? Or seek medical advice? In this case a little knowledge about a grain of wheat could save your life.

Á A tumour called a "vestibular schwannoma", formerly known as an acoustic neuroma, starts to grow on the vestibuar nerve, one of several cranial nerves. It strikes only 10 in a million people and it's ironic, that although benign, it can kill you.

Á Dr. Charles H. Tator, Chairman, Division of Neurosurgery at the University of Toronto, and a staff surgeon at the Toronto Hospital says early detection is the key to prevent dire consequences. A gradual loss of hearing is the first and earliest symptom.

Á This common symptom makes early diagnosis more difficult. After all, large numbers of people experience gradual hearing loss as they age and most of the time it's due to degenerative ear problems.

Á But there's a clue that everyone should remember. Vestibular schwannomas usually cause loss of hearing in only one ear. And the telephone is a good way for people to check their ability to hear and to pinpoint the diagnosis of this tumour.

Á Dr. Tator says that people who notice a gradual loss of hearing will unconsciously switch the telephone receiver to the other ear. But they often fail to inform the doctor. Or if they do mention the problem it's so minor it may be ignored.

Á Not all cases of unilateral deafness develop slowly. A small number of patients will be able to use the telephone in the morning with their usual ear. But not in the afternoon.

Á Ringing in the ears is another common symptom. It's often described as a whistling, humming, machinery©like noise or bells ringing.

Á But how can a benign tumour end your life? Vestibular schwannomas don't grow like a raging forest fire eventually spreading to other parts of the body. Rather they slowly increase in size over many years in a very strategic part of the brain, the cerebello©pontine angle.

This small space is comparable to the busiest intersection in the city, loaded with vital nerves, arteries, veins and the brain stem structures themselves.

Á Failure to diagnose the tumour causes pressure on these structures, facial numbness, dizziness, trouble walking, raised pressure in the head and eventual death. Only in rare situations do vestibular schwannomas stop growing in older patients.

Á On occasion I have bemoaned the fact that modern technology has pushed aside much of the compassion of medical practitioners. However, in this instance, today's technology has been a godsend for the early diagnosis of vestibular schwannoma.

Á The auditory brainstem response test (ABR) can detect these tumours 90 per cent of the time in patients with unilateral hearing loss.

Á A sound generator is placed in one ear and the electrical responses generated from the nerves and brain tissue is picked up by electrodes on the scalp. Several hundred brief stimuli are administered and the response recorded by a computer. A delayed reaction time is found in patients with this tumour.

Á The ABR is a good screening test capable of diagnosing 90 per cent of vestibular schwannoma. If there's any doubt a magnetic resonance imaging test (MRI) is done which is incredibly accurate in determining the location and size of the growth.

Á How vestibular schwannomas are treated depends on the size and age of the patient. Doctors may simply watch the growth in elderly patients and if it appears to be stabilized, do nothing. But the majority have to be surgically removed or treated with stereotactically directed radiation.

Á DR. Norman Dott, a pioneer neurosurgeon from Edinburgh University, advised many years ago that "the right time to remove this tumour is when it is no larger than a grain of wheat." Today doctors have the tests available to do this. The message is simply, don't neglect unilateral hearing loss.

Á Several weeks ago I wrote that I was tired of receiving letters asking why a loved one had to die in pain. Particularly since heroin has been available for 10 years and wasn't being used by doctors. So I asked people to give half of their cancer donation to The Gifford©Jones Foundation to build a hospice for terminal cancer patients where heroin would be available. I believed this was the only course left open to stop this inhumane attitude.

Á In the interim many readers have asked where donations can be sent. The address is The W. Gifford©Jones Foundation, Box 222, Postal Station A, Toronto, M5W IB2.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod