Auditory processing deficit in a patient with Ramsay Hunt syndrome

Objective: The present study was undertaken to investigate the auditory processing skills in an individual diagnosed as ‘herpes zoster oticus with polycranialis multiplexa involving VII, IX and X cranial nerve with lacunar infarct in the right frontal cortex’ (Ramsay Hunt syndrome type II). Prior investigation on hearing sensitivity revealed that sensorineural hearing loss with both cochlear and retrocochlear involvement was frequent in these individuals. Apart from hearing loss, multiple neurological conditions such as infections, myelopathies and vasculopathies relating to both central and peripheral nervous system, were also found to be associated with this condition. Research evidence suggested that an auditory processing disorder may be associated with all these conditions. It is, therefore, possible that auditory processing disorders may be associated with Ramsay Hunt syndrome type II. There is a dearth of literature investigating auditory processing skills in such individuals, which suggested the need to investigate such skills. Study design: This was a single case study design investigating auditory processing skills using a series of behavioural and objective tests known to be sensitive enough to assess them. Behavioural tests such as speech perception in noise, gap detection, duration pattern and duration discrimination and objective tests like speech-evoked auditory brainstem responses, click-evoked auditory middle latency responses and speech-evoked auditory middle latency responses were performed. Results: Investigations of the peripheral auditory system revealed a mild sensorineural hearing loss in the right ear and minimal hearing loss in the left ear with no indication of retrocochlear pathology. Poor scores on speech perception in noise, gap detection, duration pattern and a duration discrimination test pointed towards the presence of auditory processing disorder. These results were further confirmed using more objective tests where the absence of a far-field response component in the speech-evoked auditory brainstem response, as well as absence of the middle latency response, strengthened the behavioural test findings. Conclusions: The results of the present case study focus on the presence of auditory processing disorders and, thus, meticulous investigations of auditory processing skills are warranted in the audiological test battery of these individuals.